Phil Woolas: The implementation of tier 4 of the points based system took place on 31 March 2009, replacing the previous arrangements for overseas students to come to study in the UK. This ensures that only those colleges and schools which provide quality education and take responsibility for their students are licensed to bring in international students. We continuously monitor the systems, and where improvements can be made we will make them. The Prime Minister recently announced a review of certain elements of tier 4.

Phil Woolas: My right hon. Friend makes an important point. The value to the United Kingdom of overseas students is very great indeed in cultural and economic terms. It is a question of getting the balance right. We have evidence of abuse of the system under the old system and under the new system, but we are confident because the number of students coming to this country from overseas has increased and we have better controls over those visas.

Alan Johnson: I do not believe there is a case for looking at this in the context of a completely separate review of the treaty. We have a situation where a number of crimes are committed in the UK and we have another crime-a terrorist offence-committed against the US from someone in the UK, a British citizen, who did not leave this country at all. It is a question of what the prosecuting authorities decide in this case. Let me quote to the hon. Gentleman, because it is relevant to this issue, what Lord Justice Burnton said in the High Court in July about this particular offence. I think that it would apply to other offences where a crime is committed in another country over the internet. He said of Gary McKinnon:
	"It is true that the Claimant's offending conduct took place in this country. However, it was directed at the USA, and at computers in the USA; the information he accessed or could have accessed was US information; its confidentiality and sensitivity were American; and any damage that was inflicted was in the USA. The witnesses who can address the damage done by his offences are in America. Moreover, because the information was sensitive, it would be far more difficult for it to be put before a judge in this country than before a US judge".
	I believe that the legal profession is quite capable of deciding-to use the terminology-the forum in which any of these allegations should be prosecuted.

David Hanson: I am grateful to the hon. Gentleman for his recognition of the participation of my hon. Friend the Member for Slough (Fiona Mactaggart) in bringing that law to fruition and the importance that we give to how it is implemented and examined. We are certainly considering the hon. Gentleman's suggestions, and my hon. Friend the Under-Secretary of State is looking into these matters.

David Hanson: As I said, I refer the hon. Gentleman to the answer I gave earlier. We are very concerned about bureaucracy, and he will know that £80 million of taxpayers' money has been invested in handheld devices, reducing bureaucracy by some 30 minutes per officer per shift, by taking them away from paperwork and putting them back on the front line. That is an investment to which this Government have been committed, and-if I can be political-it is one of those investments that the Opposition may find it necessary to cut.

Andrew Pelling: Estimates are that we have 2,000 irregular migrants in Croydon-a number that might increase as a result of the closure of the Liverpool walk-in asylum centre given that Croydon is now the only inland asylum centre. How many more irregular migrants will there be in Croydon as a result of that change, and specifically, how many unaccompanied asylum seeker minors? That will lead to extra pressures on public finances.

Andrew MacKinlay: What is the problem with extraditing Nosratollah Tajik to the United States, the Iranian whom the Americans want under our wonderful extradition treaty? Is it not a fact that there are many people in London, including those in our security and intelligence services, and the banking and financial sector, who do not want him to go to the United States? How is it right to extradite Gary McKinnon and not this fella?

Gordon Brown: With permission, Mr. Speaker, I would like to make a statement on my visit to Afghanistan and to report on the conclusions of the European Council and our role in the global talks on climate change. First, Afghanistan. On Saturday and Sunday this weekend, I visited our troops in Helmand and Kandahar, and met President Karzai and his Defence, Foreign Affairs, Interior and Security Ministers. I also met our commanders on the ground, and Afghan army leaders. Today, I have had a meeting of our National Security Committee, with the Chief of Defence and the chief of our security services, and talked to NATO Secretary-General Rasmussen.
	The first purpose of my visit to Afghanistan was to thank our brave armed forces in a year in which 100 of their colleagues have made the ultimate sacrifice for our country. I wanted to acknowledge and congratulate them on the dedicated work that they continue to do, day after day, and, as Christmas draws near, to wish them and their families well. I think that I speak for everyone when I say that the thoughts and prayers of the House and the whole country are with them. British people are safer at home because our troops are fighting for our safety this Christmas in Afghanistan.
	I wanted also to assess progress to reinforce our campaign in Afghanistan, and, in my meetings with President Karzai and his team of Ministers, to begin preparations for the conference on the future of Afghanistan that will be held in London on 28 January-an event which I believe will galvanise the international effort on political and economic progress, as well as on security, and to which President Karzai has agreed to present his plans for the country's future.
	Our strategy is to ensure that al-Qaeda can never regain free rein in Afghanistan. To achieve that, we must weaken the Taliban and strengthen Afghanistan, stage by stage, district by district and province by province, putting the Afghans in control of their own security. But we must first address the Taliban insurgency with all the resources and power that we have at our disposal. Yesterday, I flew on one of the newly deployed Merlin helicopters. Over the past three years, we have doubled helicopter numbers, and more than doubled helicopter flying hours. There will be further increases in both over the coming months.
	I also saw the mine-resistant Mastiff patrol vehicles and the smaller but equally well-protected Ridgeback vehicles, and heard how since the summer we have increased the number of Mastiff by more than 80 per cent. and almost doubled the number of Ridgeback-hundreds of new vehicles funded from the Treasury reserve, which are now every month saving lives in Afghanistan.
	Aerial surveillance helps us track and target Taliban improvised explosive devices, and that surveillance has now been increased by over 20 per cent. Yesterday I asked for and received an assurance from President Karzai of the new assistance the Afghan people will give us in detecting and dismantling these improvised explosive devices. Afghan forces will now be trained, as I saw yesterday, to detect and disable IEDs. There will be more local police on the ground and we will be training 10,000 police recruits. There will be better intelligence from the Afghan people about the source of planned IED attacks and encouragement not to harbour those planning explosive attacks on British soldiers.
	I can say now that we will go further in providing more equipment and support to our armed forces. Tomorrow, the Defence Secretary will announce plans for more equipment for the Afghan campaign, including more specialist counter-IED support. The latest tranche of urgent operational funding from the Treasury will include an extra £10 million for hand-held mine detectors to follow the £12 million set aside earlier for new explosive disposal robots, over 30 of which are now in operation tracking IEDs. I can also announce a package of longer-term investment in our counter-IED capability, including new and enhanced facilities for training and for intelligence. This will amount to an extra £50 million a year-£150 million in total this year and over the next two years.
	Our strategy involves working with the Afghan army and police so that over time they can take security control. President Karzai confirmed to me that he is increasing the number of Afghan troops in Helmand to 10,000. Already in the last few days, 500 new troops have arrived. Once the police training college we are running in Helmand is at full strength from the spring, there alone we will be able to train 2,000 police officers every year.
	Yesterday I saw for myself the reality of British forces mentoring and partnering Afghan troops and the new momentum that is resulting from that. The Taliban are a determined adversary; they will not give up easily. I am under no illusion that there will be hard fighting ahead, but I draw great confidence from the immense professionalism of our servicemen and women and from the telling effect they are already having on the enemy and the galvanising impact they are having on the Afghan forces they are partnering.
	I can report that 36 countries have now offered additional manpower to the Afghan campaign. We know that the planned increase in American, British and Afghan forces over the coming weeks and months will allow us to review force ratios and develop a new balance in Helmand. As I have said to the House, the priority for the additional British forces is to thicken in central Helmand and to shift the emphasis towards partnering Afghan forces. I can report to the House that commanders on the ground told me yesterday that already in two thirds of British bases, our forces patrol jointly with their Afghan counterparts. It is by partnering in this way-first in the army and then with the police-that we will enable the Afghans to step up to the challenge of dealing with the Taliban and with extremism, and, ultimately, when the conditions are right, that we will allow our troops to return home.
	I also saw from my visit and from my discussions with our commanders and civilian leaders that we are seeing the beginnings of the political process, which must complement our military strategy. Tribal and town elders already provide the kind of effective, accountable grass-roots government that will be the foundation for any successful political strategy.
	So the decisions we have made in 2009 set a new framework for action in 2010. Partnership with Afghan forces will turn Afghanisation from an aspiration into a real force for progress in every district. Even closer working between our military and civilian missions will allow military action to provide the space for Afghan institutions owned by the Afghan people to develop at a faster pace.
	Mr. Speaker, 68 international delegations will come to London for the 28 January conference on Afghanistan. All 43 powers engaged in the international coalition will attend, together with other regional and Muslim partners and international organisations, and they will be led by the Secretaries-General of the United Nations and NATO. I agreed with President Karzai that this conference will deliver a new compact between Afghanistan and the international community based on priorities that he has outlined.
	The first of those priorities is security. We expect nations to announce troop deployments building on the total of 140,000 troops promised for 2010. I hope that the London conference will also be able to set out the next stage in a longer-term plan: the changing balance between alliance forces and Afghan army and defence forces as the number of Afghan forces increases from 90,000 to 135,000 next year and possibly to 175,000 later, as well as, of course, the future numbers, roles and tasks of the police, intelligence services and local security initiatives in Afghanistan.
	Secondly, in London, NATO and international security assistance force partners must set out an outline programme for the transfer of lead responsibility from coalition to Afghan forces, along with an agreed set of conditions and criteria to establish the eligibility of provinces and districts for transfer. I hope we can agree in London that that process can begin during 2010, subject to conditions on the ground.
	The third priority relates to reintegration. London must secure international support and financial backing for Afghan-led resettlement and reintegration programmes. Fourthly, there is the issue of economic development. As President Karzai proceeds with an anti-corruption programme, London must provide comprehensive long-term support for the Afghan economy, including support for farmers and working people in the towns and villages, in order to offer them a greater stake in the future of their country. That will include providing Afghans with credible alternatives to the poppy and the insurgency.
	Finally, London must address the issue of co-ordinating international efforts on Afghanistan. That means reaffirming the role of the United Nations, announcing the new special representative of the Secretary-General, and announcing stronger civilian co-ordination in ISAF. London must also encourage a new set of relationships between Afghanistan and its neighbours, and, in particular, better joint working with Pakistan.
	Although Afghanistan and Pakistan are different countries with their own cultural traditions and histories, they are both at the epicentre of global terrorism. Our national security interests require us to deny al-Qaeda space in which to operate across Pakistan, and also to deny it the option of returning to operate in Afghanistan. One of the biggest advances of the last year is increased co-operation with the Pakistan authorities in support of the efforts involved in the fight against the Taliban and al-Qaeda, and we want to build on that in the coming months.
	As part of our partnership with the Pakistani armed forces, construction is now under way of the new UK-funded Baluchistan training facility, in which British mentors will be working with Pakistani training staff to build counter-insurgency capability for the 30,000-strong Baluchistan frontier corps. As part of our partnership with the civilian Government of Pakistan, the new education taskforce, which is focused on implementing education reforms, is meeting for the first time today in Islamabad. Moreover, £250 million of Britain's development assistance to Pakistan is directed towards education, as I agreed with President Zardari earlier this month, because nothing is more important to addressing the root causes of so many of Pakistan's problems than the building of a strong universal state education system, free from extremist influence and offering a viable alternative to low-quality schools, which include the poorly regulated and extremist madrassahs.
	One of the first decisions of the European Council was to reiterate its strong commitments to promoting stability and development in Afghanistan and Pakistan. A second decision was to express the united view of Europe that there was "grave concern" about Iran's nuclear weapons intentions. We recognised-here I quote from the communiqué-that Iran has
	"so far done nothing to rebuild confidence of the international community in the exclusively peaceful nature of its nuclear programme."
	While we agreed that our offer of renegotiation and negotiation remains on the table, because of our continuing concerns about Iran's nuclear programme we agreed to begin working on options for sanctions in the new year.
	The Council also discussed the economic recovery, jobs and sustainable growth, and how Europe could move forward a climate change deal at Copenhagen. We reiterated unanimously that policies in support of the economy should
	"remain in place and only be withdrawn when recovery is fully secured."
	The Council
	"welcomed the rapid and determined action"
	taken across Europe to strengthen financial regulation and supervision. It also agreed that
	"Remuneration policies within the financial sector must promote sound and effective risk management".
	Following the introduction in the UK of an additional bank payroll tax when bank and building society employees' discretionary bonuses are above £25,000, the Council encouraged
	"Member States to promptly consider available short-term options"
	to implement "sound compensation practices".
	Fourthly, in response to a British initiative, the Council emphasised
	"the importance of renewing the economic and social contract between financial institutions and the society they serve and of ensuring that the public benefits in good times and is protected from risk."
	The Council encouraged the International Monetary Fund in its review to
	"consider the full range of options including insurance fees, resolution funds, contingent capital arrangements and a global financial transaction levy."
	There are very few moments in history when nations are together summoned to make common decisions that will reshape the lives of every family, potentially for generations to come. Our aim must be an ambitious climate change deal in Copenhagen that will enable the European Union to make good its commitment that we
	"move to a 30 per cent. reduction"
	in carbon emission levels
	"by 2020 compared to 1990".
	The agreement in Copenhagen must also include a clear financial framework for the short, medium and longer terms. This financial agreement must address the great injustice that is climate change: that those hit first and hardest by climate change are those who have done least harm; and that, in fact, 98 per cent. of those most severely affected and dying live in the poorest countries, which account for only 8 per cent. of global emissions. So it is essential that we honour our responsibility for helping meet the costs they face in adapting to, and mitigating the consequences of, climate change.
	I can report to the House that, to assist in adaptation and mitigation, the European Union has pledged €7.2 billion-or £6.6 billion-over three years; that is €2.4 billion for each of the years 2010, 2011 and 2012. This should enable the world to reach its aim of $10 billion in climate change help for each year until 2012. Let me say that this financial agreement could not have got off the ground without the strongest European co-operation.
	Britain will contribute £1.5 billion, but there must also be additional and predictable finance in the medium term to 2020 and beyond. The figure of €100 billion has been set for the long-term climate change needs of developing countries by 2020, and the European Council reconfirmed its commitment to "provide its fair share" of this international public support. I can say to the House that from 2013 the UK will provide additional climate finance over and above our 0.7 per cent. overseas development commitment, and that the European Council reaffirmed its "official development assistance commitments" in view of the
	"impact of the economic crisis on the poorest."
	There is an urgent need to support rainforest countries. Twenty per cent. of early finance should be allocated to forest protection. To achieve a reduction in deforestation of 25 per cent. by 2015, leading to a 50 per cent. reduction in 2020 and a complete halt in 2030, will require global financing of about $25 billion over the period 2010-15. A majority of that should come from developed countries, to support the rainforest countries' own efforts.
	Today, we send a message to all of Europe and to the world: there is work to do. We are only halfway to an agreement. Now is the time for developed and developing countries not to divide among each other, but to do what no conference of 192 countries has ever achieved before: to come together with a forward-looking programme to advance our shared goals.
	This week, world leaders are gathering in Copenhagen and, as I have indicated to the House authorities and Opposition leaders, I will join global leaders in Copenhagen, starting from Tuesday with meetings with leaders from the African Union and the European Union, and the UN Secretary-General and the Danish presidency, as well as representatives from the hard-hit small island states.
	The agreement at Copenhagen must be ambitious, global, legally binding within months, consistent with a maximum global warming of 2° C and ensure the fairest financial settlement for the poorest countries. Britain, our European partners and the Commonwealth will continue to work tirelessly for the best result at Copenhagen, and I commend this statement to the House.

David Cameron: The European Council covered three main areas: foreign affairs, the environment and economic issues. I want to ask about all three, as well as the vital issue of Afghanistan.
	On Afghanistan, as the Prime Minister knows, we have supported the increase in US and UK troop numbers, and, as the Prime Minister has said, at Christmas time we should all be thinking of our forces and their families. I would like to pay tribute to all those charities and organisations sending gifts, cards and presents to our forces in Afghanistan. Our forces should be on our minds for all that they are doing.
	On strategy, we believe that this is the last best opportunity to get this right. Does the Prime Minister not agree that everything now needs to be brought together, including having the right concentration of troops in every part of southern Afghanistan? He talked about thickening the troop presence in central Helmand, and we look forward to hearing more about that. Perhaps he can tell us when he will be able to update the House on what is being done specifically to make sure that British troops cover fewer areas, in greater density-we believe that that is vital.
	On the issue of the Afghan national army-the Prime Minister, like me, saw it being trained at first hand, and it is incredibly impressive-does he agree that we are now probably going as fast as we can and that to go any faster would involve a danger that the quality of recruits would suffer? Can he tell the House a little about what is being done to make sure that those Afghan national army recruits who are trained and then sent to the south of Afghanistan actually go to the south of Afghanistan, and that the units function properly?
	On the London conference, about which the Prime Minister said quite a lot, could he give clarification about the new individual working on behalf of the UN Secretary-General? Does he still agree with us that it would be good to have someone over and above that to co-ordinate all the civilian side, rather in the same way that Stanley McChrystal is co-ordinating all the military side? That is what we have been pushing for, and perhaps the Prime Minister could clarify whether that is still the Government's position.
	On Iran, does the Prime Minister agree that the time has come for the EU to take a much stronger line? It is clear that talks with Iran are not moving, but the summit just referred to "considering", as the Prime Minister said, options for next steps. Should not those specifically include three things at the very least: a tough new inspections regime on Iranian cargo; a ban on any new European investment in Iranian oil and gas; and serious financial sanctions like those that exist in the United States? We have been here before. The Prime Minister said in June 2008 that
	"action will start today for a new phase of sanctions on oil and gas."
	Can he assure the House that this time the essential measures will be finally agreed and put into place?
	On Copenhagen, can the Prime Minister be clear about what he thinks can now be achieved? Does he agree with Yvo de Boer, the UN's chief climate negotiator, that achieving a full legally binding agreement is no longer possible at Copenhagen itself? If he is right about that, is it not essential that we see a full political declaration agreed this week? Is that not the minimum that the world has a right to expect? Does the Prime Minister agree with us that it is vital that any agreement is consistent with keeping global warming below the 2° C threshold?
	On the issue of funding, the Prime Minister gave us the figures, but could he tell us a bit more about where the money is coming from? The UK's contribution was originally £800 million, then it was £1.2 billion and then it was £1.5 billion. Can he tell us where this is coming from? If, as the Prime Minister's spokesman said on Friday, it is coming from the aid budget, can the Prime Minister tell us whether this will have any impact on other aid programmes?
	Turning to economic issues, this Prime Minister once described the UK budget rebate as "non-negotiable"-that was before he gave £7 billion of that rebate away. When he did so-this is the reason for asking the question today-Tony Blair said that the Government had obtained in return a review of the EU budget. That was meant to start in 2008 and to finish by the end of 2009, but it is absolutely nowhere near finishing. Indeed, in the draft summit conclusions the deadline slipped to next July, and in the final conclusions it slipped another six months, to the end of 2010. At a time when budgets are being cut in the UK, does the Prime Minister agree that in reviewing the EU budget, the main purpose should be to push for a real-terms cut in that budget? Does he also think that while public servants in this country are getting low pay increases or even, in some cases, pay freezes, it is completely wrong for EU civil servants to receive a 3.7 per cent. pay rise?
	Turning to the new Commission, is it not the case that the Prime Minister's whole approach to this has been wrong from start to finish? He started by spending valuable political capital on a completely misconceived plan to make Tony Blair President of Europe and ended with Britain having none of the key economic portfolios. Indeed, the Government became so dysfunctional that at one stage Peter Mandelson tried to land himself the job of High Representative. The Prime Minister shakes his head, but perhaps he should just nod. Did Lord Mandelson try to get the job? Is there anybody in there? He was frantically hitting the phones, apparently-the rat was trying to leave the sinking ship, but he is still on board.
	Friends of Lord Mandelson, which always used to mean Peter Mandelson himself, said that he thought the whole thing, not pathetic, but "botched". That was his word. Is that not the right description for the Prime Minister's handling of this affair?
	On financial services, cross-border co-operation is clearly vital. However, will the Prime Minister confirm that Britain has effectively given up its veto on blocking regulatory decisions in times of crisis when there is a disagreement over whether there are financial consequences for the taxpayer? He did not mention that in his statement-perhaps he can answer it when he has finished chuntering from a sedentary position.
	The summit conclusions also called for the restoration of sound public finances. May I ask the Prime Minister whether he ever expected to come back from a European summit as Prime Minister after 12 years' stewardship of Britain's finances with the biggest deficit of any major economy, with Britain the only G20 country still mired in recession and with the worst outlook for public finances in a generation? Is that what he meant by leading the way in Europe?

Nicholas Clegg: I would like to thank the Prime Minister for his statement, and of course to add my expressions of gratitude to our armed forces who are serving so bravely and selflessly in Afghanistan. With families across the country preparing to come together for the Christmas holidays, may I also pay tribute to the families and friends of our servicemen and women? The enormous sacrifices they are also making for this war are uppermost in all our minds at this time of year.
	I am grateful to the Prime Minister for his detailed statement on Afghanistan, but I should like to seek clarity on two points. First, will he clarify what he believes to be the role of China, Russia and Iran? Whether we like it or not, those nations are absolutely crucial in securing long-term stability in Afghanistan. I was not quite sure, from what he said, whether any or all three of those nations will be represented at the London conference. If they will not, will he provide us with some detail about how we might engage with all three of them to help to stabilise Afghanistan, notwithstanding the other major differences that we have, particularly with Iran at this particular time?
	The second point is this. We all know that the war in Afghanistan will be won only if we win the battle for the hearts and minds of the Afghan people. In turn, that is heavily dependent on the legitimacy of President Karzai and his Government in Kabul. The Prime Minister referred to President Karzai's efforts against corruption, but could he tell me how exactly he will judge progress on good governance and against corruption in Afghanistan by the time President Karzai comes to the London conference in January?
	Given that the resources allocated and the strategy we have been pursuing in Afghanistan during the past eight years were so heavily influenced by the war in Iraq, I should like to know what the Prime Minister thought of his predecessor's admission this weekend that he would have invaded Iraq whether there were weapons of mass destruction or not. The Prime Minister not only supported his then boss in taking us to war, but he also signed all the cheques, so people have a right to know: does the Prime Minister agree with Tony Blair that the invasion would have been justified even without the paper-thin excuse of weapons of mass destruction?
	Finally, on climate change, a few hours ago we heard that the talks in Copenhagen were suspended-although I am told that they restarted a few minutes ago-because of differences in the international community between the developing and developed world. I am sure the Prime Minister agrees that the "I will if you will" brinkmanship needs to come to an end. Too many players are making their commitments conditional only on the commitments of others, so will the Prime Minister make a unilateral commitment to help break that deadlock? The Committee on Climate Change said that to meet the European Union target of 30 per cent. cuts on 1990 levels by 2020, the UK would need to cut its emissions by 42 per cent. by 2020. The Prime Minister does not need to wait for anyone else to make that commitment. Will he make it today?

Gordon Brown: My right hon. Friend is right. We made representations about the Shi'a family law that was discussed in the summer. The President ensured that some of the discriminatory parts of that were removed as a result of international pressure, as well as people in his own country, including women, urging that he change the position. I realise that the rights of women in Afghanistan are an issue that we must promote at all times when we are discussing the future of Afghanistan.
	It is true that as a result of what has happened over the past few years, whereas no girls went to school, there are now 2.5 million girls at school. For the future of Afghanistan, that is a vital change that is happening. Increasing the numbers of children at school, including girls, is a vital part of the programme. At the same time, maternal mortality was among the worst in the world. I understand that one in eight births ended in the death of the mother as a result of the inadequate facilities. I am told that recent research suggests that 100,000 children are now surviving to the age of five who would otherwise not have done so, as a result of the improvements in tackling infant mortality and child health. These achievements are a result of bringing health and education to the people of Afghanistan. My right hon. Friend is right: we must never forget the importance of these issues-the social and economic improvement of the condition of the population-when we are talking about the future of Afghanistan.

Anne Main: The Prime Minister did not answer the leader of the Liberal Democrats on the case for going to war in Iraq on the grounds that it would be inappropriate because an inquiry on that is being done at the moment. Does he believe, then, that his Defence Secretary's remarks on condemning going to war without giving correct proof were inappropriate?

Gordon Brown: My hon. Friend has taken a long-term interest in the problems faced by those island states, where we could be dealing with climate-change refugees and evacuees in the not too distant future. Copenhagen is important, because it can allow us to make a commitment to help immediately those island states that are facing these immense difficulties, and help them to obtain support to deal with the adaptation necessary. We will not forget the challenges faced by these islands. Many of them are part of the Commonwealth and it is important that we come to their aid when they are in need.

Gordon Brown: China and India must be central to an agreement in Copenhagen. As we know, one of the great problems of the previous Kyoto agreement was the number of countries not involved in it. It is crucial that China plays its part in the negotiations. It is one of the biggest, if not now the biggest, emitters. It is also crucial that India, which is also growing fast, plays its part in the negotiations. I will meet Premier Wen and, I hope, talk to Prime Minister Singh in the next few days. We will try to work together to secure the necessary agreement.

Tobias Ellwood: Will the Prime Minister join me in paying tribute to our armed forces-not just those in combat roles, but those doing humanitarian work in areas where the international development agencies cannot operate-building bridges, building schools and so forth? Does that good work count towards the UN target of 0.7 per cent. of gross domestic product?

Gordon Brown: We are part of a European Union of 27 members. I know that many people on the Opposition Benches do not like that fact, but one of the responsibilities of membership is that we provide resources for all members of the European Union, depending on our ability to pay. That has been the agreement in the agreements that have been negotiated, and these agreements are in the interest of a country that trades 60 per cent. of its goods with the European Union, has 3 million jobs dependent on the European Union and has 750,000 companies that are involved with the European Union. If the hon. Gentleman wishes to indulge the anti-Europeanism of the Tory party, then let him do it, but I believe that the whole of the British nation sees the importance of our relationship with Europe.

Gordon Brown: Yesterday I saw our British forces training the Afghan forces in the handheld equipment that is necessary to detect IEDs. Most of the work that we are doing on IEDs with robotic equipment is done by British forces, but over time it must be our aim to train the Afghan forces, so that they can take responsibility for the security of those districts and provinces. That, I believe, is the proper strategy for Afghanistan, and I hope that there will be all-party support for it.

Andy Burnham: I repeat what I said a moment ago. The measure paves the way for a major reform of the system in two ways. First, it is fairer in terms of funding. The people we are talking about will in the vast majority of cases already have paid significant sums out of their own pockets as their care has deteriorated. Any reform we are talking about in social care is about spreading that burden of the costs of care more fairly and not letting those who are dealt the hardest hand of cards in life and who face the greatest needs bear all the costs on their own. That was the principle that underpinned the creation of the national health service and we believe that the same principle should be valid here.
	The second point I would draw the hon. Gentleman's attention to is the focus on reablement and prevention. It is very important that we find a better way of investing in people's good health-investing the resources we have on the health service side and in terms of council funding-to create a more forward-looking preventive system that is geared around promoting people's independence, good health and supporting them to stay at home. For those two clear reasons, I say to him that the Bill is a bridge towards the National Care Service that we wish to see.
	Sixty-three years ago, this House voted to create the NHS to end the unfairness whereby people with the greatest needs faced the highest costs and the people who had the least were in danger of going without their needs being met at all. Today, the same unfairness exists in social care. If someone happens to develop dementia in old age, rather than cancer or heart disease, they are yet to find the "freedom from fear" that was the promise of the NHS. That was an enduring unfairness, which until now this House has failed to address. It becomes more and more evident as people live longer and we can no longer afford to ignore it.

Andy Burnham: The hon. Gentleman is right to raise funding because it raises real challenges both at the national level and for local authorities, but he is not right to say that councils will be asked to find the majority of the funding. I have re-prioritised my budgets within the Department of Health to find the majority of the funding necessary. We are clear, however, that efficiencies and the potential for efficiencies have been identified within social care in local government that will enable local authorities to make a contribution to the costs of this care. There is already evidence from around the country that a stronger focus on prevention and reablement can help to save local authority resources in the long term.
	As I said, the first aim of the Bill is immediate action for 280,000 people with the highest care needs, including those with advanced dementia, Parkinson's and other conditions. It does that by lifting the restriction in the Community Care (Delayed Discharges Etc.) Act 2003 on the period of time for which councils can be required to provide free personal care for people living at home.
	We know that many people want to remain in their own homes if possible. A 2004 survey found that most people expressed a preference for staying in their own homes, 62 per cent. with care and support from family and friends and 56 per cent. with care and support from trained care workers. Only last month, in its "Findings" series, the Joseph Rowntree Foundation concluded:
	"Older people most often move to a care home as a result of crisis, with no preparation and little or no planning. Most do not choose to be there."
	Currently an estimated 80,000 older people in greatest need receive free personal care, but 40,000 pay part of their own costs and 50,000 pay all their costs. An estimated 90,000 younger adults receive free care, while 20,000 pay all or part of their own costs. The Bill will end that lottery, and remove the enormous and unfair financial burden on such people and their families.
	Those figures answer the question asked by the hon. Member for North Norfolk (Norman Lamb) a moment ago. The Bill will provide free care for some people who are currently paying all or part of their costs, and it guarantees that all members of that category will receive it in the future. As the hon. Gentleman knows, under the current system a local authority could change the eligibility criteria and, at any point, bring some of the people who currently receive free care into the ambit of charges.

Brooks Newmark: The Secretary of State's comments will be extremely helpful to my constituents in Braintree. Each and every week I meet one or two people who give a lot of their time, and who ask me, "Can the state to do more to help me, not on a financial basis, but on an enabling basis?" If the Secretary of State could give me one or two examples of how his Government will do that, that would be helpful.

Andy Burnham: The hon. Gentleman makes an important point. There are some people for whom reablement, or intensive support, would not be appropriate. He gave as an example people who receive palliative care, and that is obviously true for them. Nobody would want anything in the Bill to place pressure on people or put them through a process that they must and should not go through. The regulations under the legislation will make that clear. Of course, the measures should not deny such people any support should they qualify under the relevant terms.
	We believe that by investing in reablement we can prevent emergency admissions to hospital, prevent people from ending up in crisis situations and help people live independently in their homes for longer. I have mentioned the Isle of Wight a few times. It has had a 40 per cent. reduction in residential care placements since it introduced free personal care in the home. That work is already going on in other places and showing its worth. The Wirral is also taking a lead on investment in reablement services. Let me give an example.
	A 77-year-old woman who had been dependent on carers for two years was admitted to hospital for aortic valve surgery. She had got used to doing very little for herself; she was sleeping downstairs and was using a bowl of water in the lounge and a commode to meet her personal care needs. On discharge, she received three visits a day from the home assessment and reablement team to help her with personal care and meal preparation. The team helped her to practise using the stairs and encouraged her to undertake daily tasks such as opening the curtains, putting on the washing and making her own lunch. Over six weeks, the number of visits that were required gradually decreased, and she is now living happily and independently without any intervention from social services. Such inspiring examples show how we can help people to regain independence and how we can spend public money more effectively.
	In that way, the Bill aims to enable people to retain their independence, as well as aiming to reduce costs and prevent ill health. It will help to ensure that people remain economically active by providing the support and control that families and carers need to balance work and caring. We want to build on the work that many councils have already begun on prevention and intervention to support people in living independently in the community. The Bill encourages, but does not require, councils to offer a reablement package. The offer of free personal care and better use of resources will push authorities to bring in alternative models of care and will embed prevention and reablement, all of which have been shown to be more cost effective and to offer better outcomes. That approach could help authorities to generate by 2013 the £250 million that early estimates suggest will be the additional cost of free personal care. It will reduce the cost of care for individuals, including those who continue to fund their own care, and will help people to stay independent. By extending a hand to those with lower-level needs, we can help to reduce isolation and help to keep people active. In doing so, we can prevent people from slipping to the point at which more intensive care and support is required.
	There has been a great deal of speculation and misinformation about how the Bill will be funded, so I shall take this opportunity to explain our approach again in the clearest terms possible. The measures we are proposing will cost £670 million in the first full year, which will be provided entirely from the Department of Health budget and by local government. Some £420 million will come from the Department, and the remainder will be met by local authorities. That funding, along with the scope for further efficiency gains, will be considered as part of the normal spending review process. It is right that councils should play their part alongside central Government in helping to deliver the commitment on free personal care. We will be consulting on the distribution mechanism for local authorities. I repeat that it is completely incorrect to say that any of the money will come from cutting disability benefits or from cutting cancer research or any other important research.

Andrew Lansley: I am sure the House is grateful to the Secretary of State for taking so many interventions with a view to understanding not only the purpose of the Bill, but how it is intended to work. Although it is a short Bill, considerable complications arise from it.
	The debate on the principles of the Bill takes place in the context of the Government's Green Paper and the reform of social care and support. There are two topics that hon. Members across the House would not want to leave out of account in considering how we should reform care and support for the future. First, we must continuously look beyond organisation and funding issues to understand the quality of the service being provided to people at home or in residential care homes. The Care Quality Commission report a fortnight ago on social care made it clear that a considerable proportion-about one in four-of care providers are not yet meeting the good or excellent standards that we would expect for ourselves or our relatives.

Andrew Lansley: I have not really begun yet, but I shall of course give way in a minute.
	I find the situation very strange, because over the past decade Scotland has increasingly demonstrated that a policy of free personal care is unaffordable. Indeed, colleagues from other countries in the United Kingdom are present, and owing to the circumstances in which the policy was applied in Scotland, it has cost a great deal more than the authorities intended and they have had to cash-limit it, introducing therefore just the kind of unfairness in terms of access against which the Secretary of State now rails. Furthermore, the policy does not meet the accommodation costs of those in long-term residential care, so those costs have also escalated. The policy has not made people feel the intended sense of financial security.
	Those are all the reasons why a Labour Government said for many years that free personal care, as Scotland has offered it, is simply unaffordable in England and cannot be supported. I do not dispute that we supported that conclusion, because I made the same point myself. Indeed, a Government Green Paper published as recently as July said that to pay for the costs of care out of general taxation would impose an unreasonable burden on those of working age; that it would have a major, further distributional impact between generations and on those who continue to work; and that the Government therefore ruled it out. In July, as far as we were concerned, the Labour party was continuing to rule out free personal care, but in September, the Prime Minister got up at the Labour party conference and said that he wanted to offer free personal care paid for out of general taxation.
	There is no sense in which the Bill constitutes a bridge between the current position and the options in the Green Paper with which the Government are proceeding. They are talking about three options: the partnership model with universal care and a third of it paid for up front, a comprehensive insurance model, or an involuntary insurance model. Under none of the three models in the Green Paper would those with substantial or critical care needs have all their needs met out of general taxation.

Andrew Lansley: The Minister tempts me, but I will not do so. The hon. Member for Leeds, North-West (Greg Mulholland) asks about a March election. For that to happen, it must be called at the end of February, but the consultation on the regulations on this legislation will conclude only on about 23 February. Clearly, the Bill is more about propaganda for a general election than the delivery of social care reform after it.
	None the less, we are debating the structure of care reform. There are two serious problems with some of the options presented in the Green Paper. First-I will not go on at great length about this because we debated it in Opposition time last Tuesday-there is serious difficulty with the Government's intention to integrate disability benefits into the national care service funding. Of course, the Government did a U-turn last Tuesday and completely changed the proposal to integrate for current benefit recipients. It is fascinating that the Government are now proposing that over-65s who receive attendance allowance-let us say £60 a week on average-and disability living allowance should have that money taken away, so that it can be given to the local authority and then given back to them to spend in exactly the same way.

Andrew Lansley: Apparently that will happen with no loss in transaction costs in the process. That is absurd. We know why the Government have ended up in that position. Under pressure, they did a U-turn, but to put it gently, it has left them looking very exposed.
	For the longer term of the introduction of the reforms, the Government intend to integrate those disability benefits to pay for the up-front, universal entitlement to care. The effect would be to take away a cash benefit that recipients can use to meet a range of needs and costs and to substitute a care package. From our point of view, that remains unacceptable. We need to buttress and strengthen the right to control, and to personalise, care services, and continuing access to a cash benefit remains important for that to happen.
	In response to the Secretary of State's statement on the Green Paper in July, I said that it is important to reach a common assessment of need-one that informs the non-means-tested cash benefit and the means-tested or insurance-funded social care entitlement. As with the extension of personal health care budgets, care users need the assessment process overall to become simpler and more integrated, for the resulting budgets and assessment processes that arise to be applied flexibly to meet their needs, for there to be a choice of providers, and for the assessment of need to be portable, as people will inevitably move around the country.

Andrew Lansley: According to the Secretary of State, the Bill is supposed to be associated with the Green Paper and to be a bridge to it.
	I am grateful to my hon. Friend the Member for Eddisbury (Mr. O'Brien) for reminding me that the noble Lord Warner said:
	"We need a more bipartisan and coherent approach than is provided for in this Bill...I am resigning myself to the fact that many of us will have to try to make the Bill more sensible and realistic about costs and funding arrangements",
	and I agree.
	He continued:
	"Good places to start would be some national rules on service eligibility criteria to avoid a postcode lottery and making local assessments of individuals portable to other areas."-[ Official Report, House of Lords, 26 November 2009; Vol. 715, c. 541-2.]
	So the idea of portability of assessment is rightly being pursued in the other place.
	The second difficulty with the Bill is that the Government just do not seem to have an idea of how many informal self-funders there are. The Local Government Association, in its response to the Bill, said:
	"We are concerned that the actual number of beneficiaries (and therefore costs) could turn out to be very different from the Government's estimates. The Impact Assessment which accompanies the Bill provides little reassurance. We are particularly concerned that the estimated number of people with high care needs who self-fund their care may be too low."
	Counsel and Care said, similarly:
	"We need to see exactly who will be helped as a result of free personal care at home. To this end, the following areas require further definition...what are 'critical' as opposed to 'substantial' care needs, what 'personal care at home' will cover in full, when the NHS should step in and fund the care."
	Age UK said:
	"We would like clarification about the definition of personal care at home, especially when services described may be better delivered outside the home or where personal budgets are currently used to deliver similar outcomes. There is significant uncertainty about the true costs of the proposals as we do not know how many people who do not currently receive services might come forward."
	That is why we cannot have any confidence about what the cost of this Bill will be. By their own admission, the Government have nothing other than a gross estimate-a generalised estimate-of how many people are receiving informal or family care, or who are self-funding but not using council-arranged care. The evidence from Scotland demonstrates that large numbers of those people start to become claimants of free personal care if it is offered to them.
	The Bill appears to be unfunded. In the explanatory notes to the Bill, which sometimes explain and sometimes do not, I was astonished by a sentence in paragraph 17:
	"The Government's view is that the Bill has little overall effect on public sector manpower and public expenditure."
	So £670 million-on the Government's estimate-is of little effect. Convert that figure into dollars and we really have arrived at a billion here or a billion there. Soon that adds up to real money, but that does not seem to matter to the Government.
	Where will that money come from? In response to an intervention, the Secretary of State seemed to be completely unable to explain why, in last week's pre-Budget report, what should have been represented as a £200 million transfer from the NHS in England into the Department of Health's expenditure simply does not appear in the Red Book. I am astonished that the Secretary of State could not explain that. He was at pains to mention the "myths" about where the money would come from, so perhaps he can explain where it will come from. He has been quoted as saying that some £60 million of it will come from "lower priority research projects". Which are these lower priority projects? Which such projects did the Government see fit to fund in the first place?
	I have seen a long list of research projects, and the Government used to make considerable play of the fact that they had increased the NHS research and development budgets. Which advertising campaigns will the Secretary of State stop to pay for this Bill? Will it be tobacco control, the current swine flu campaign, next year's seasonal flu campaign, the sexual health campaigns or the Department's contribution to "Frank", the drug campaign? And which local authority activities will contribute the £250 million? On the face of it, the Government are arguing that it will come from a reduction in residential care home payments, but the impact assessment does not suggest that anything like that number of people will switch from residential care. The Department think that only 2,700 people would transfer from residential to domiciliary care.
	Nor does the Green Paper offer a credible way forward in relation to insurance funding. The compulsory process is not really a basis for consensus because, in effect, it would just transfer into compulsory insurance something that would, to all intents and purposes, be just a taxation per head. Compulsion and tax amount to much the same thing.

Andrew Lansley: I am sorry, but the hon. Gentleman completely misunderstands what I am saying. I am not disputing the benefits of extra care housing. What I am disputing is the fact that, in their contrivance that free personal care will be available to people with critical care needs who live in extra care housing, the Government, whether intentionally or not, are creating a potential loophole for people who are currently in long-term residential care, who would not be regarded as being in extra care housing. They will inevitably restructure their arrangements at the point at which they enter care in order to make themselves eligible for free personal care, by distinguishing the accommodation element from the care element. The Bill does nothing to prevent that from happening. That seems to be an obvious flaw in the legislation.
	The Bill is not well thought through, but is it well costed? Let us have a look at its impact assessment, which has one or two obvious flaws. On page 2, it manages to state that the average annual costs and benefits are exactly the same-£670 million-even though the total benefits are calculated as being £454 million more. Given that the Government are arguing-on the first page of the impact assessment-that the total benefits are greater than the costs, one would have thought that the average annual benefit would therefore be greater than the cost. That might be a simple error in how the impact assessment was transcribed, but as the hon. Member for Corby (Phil Hope), the care services Minister, signed it and the error was on page 2 of what he signed, he might also be able to explain why that should be the case.
	It is also estimated in the impact assessment-based on what evidence we do not know-that 10 per cent. of the flow into residential care will switch to home care. On page 15 of the impact assessment, the net flow into residential care is stated as being 178,000 older people a year, 10 per cent. of which would be 17,800. However, in the table calculating the costs by reference to the number of people who would access free personal care, the figure referred to by the Government is not 17,800 a year, but just 2,384. Such a large difference in the number of claimants would mean an extra £77 million a year to provide free personal care that has not been taken into account.
	In calculating the benefits of the policy in the impact assessment, the Government admit that most of the cost is a straight transfer payment from taxpayers for the benefit of those who have previously paid for care themselves. The calculation of the benefit of that is based on two elements. The first is the equity assumed to be gained by transferring cost from the general population to older people who fall into, on average, lower segments of income distribution in the population; therefore, there is a distributional equity gain over the population as a whole. Unfortunately, the calculations in the impact assessment are mathematically incorrect. They also use the upper weightings of the Treasury Green Book, rather than the mid-point averages. If those two things were corrected-the mathematics and the use of the mid-point averages-the overall benefit of that element would be reduced to zero.
	The second element is the assumption that people benefit because they would pay extra for certainty, in the same way that they pay extra for the certainty reflected in an insurance premium. In the impact assessment, the Government use US health insurance as a proxy for UK personal care insurance. They therefore assert that the medical loss ratio on health insurance would apply equally in this country to personal care insurance. Both points are wrong. There is no justification for making the assumption that health insurance is treated by people in the same way as personal care insurance. We know that that is so here, because we do not have a market for social care insurance; as things stand, people are not willing to pay for that certainty, whereas large numbers of people are willing to pay a premium for medical insurance in circumstances where, frankly, they often do not need to.
	The difference between health insurance and personal care insurance is perfectly obvious, but in any case, the Government assume in their Green Paper that only 20 per cent. of people would pay voluntarily for care insurance. If we simply reduced the benefit to 20 per cent.-at the moment, the Government have assumed that everybody getting personal care would have valued it as if they had been willing to pay for personal care insurance-the overall benefit in the calculation would be reduced from £365 million to £51 million. The overall effect of reducing those benefits-the benefits that justified the cost-benefit analysis in the impact assessment-is that the total costs exceed the benefits. In addition, when the £402 million opportunity cost of raising the taxation required to fund the measure is taken into account, as it should be, the policy has a significant cost in excess of the benefit.
	Of course, the care services Minister was no doubt untroubled by any of those thoughts when he signed the impact assessment on 22 November. I am sure, therefore, that he will wish to disclose in full to the House his scrutiny of the impact assessment in responding to this debate. If he does not do so, he will doubtless want to do so in response to the freedom of information request I made today, asking him what questions he asked on the impact assessment before he signed it.
	This is a short Bill, but it requires amendment to become much more flexible if it is to help in the longer-term process of delivering social care reform. It needs to accommodate insurance-based solutions. Amendments are also required to make much clearer the range of preventive measures and solutions that can be provided by local authorities. As I have said, the Bill also seems to have a serious potential flaw, in that it would distort the care market. It therefore also needs to show flexibility regarding domiciliary care and long-term residential care.
	Members of the Labour party in another place have been pretty critical of the Bill. Lord Lipsey said:
	"There was this Green Paper process going on, and then came along what somebody somewhere dubbed the Exocet:"-
	I am not sure who dubbed it the Exocet; perhaps he did-
	"the Prime Minister's conference speech in which he proposed free personal care for all at home...the suspicion is born that it owed less to a careful policy consideration and more to the natural desire of all politicians to have a nice announcement to put in their conference speech."-[ Official Report, House of Lords, 26 November 2009; Vol. 715, c. 546.]
	In the same debate, Lord Warner said:
	"I do not see it as likely to be a particularly useful stepping stone to the wider reforms that the Government were...engaged on. It is not thought through and, to many people, it looks like a political gimmick."-[ Official Report, House of Lords, 26 November 2009; Vol. 715, c. 541.]
	The Government could of course close their ears to criticism now and use their majority to push the Bill through the House of Commons, but it would then get bogged down in the House of Lords. Alternatively, they could make time available to work with us in this place to try to make the Bill a genuine bridge towards the reform of long-term care and support, to make it enabling rather than prescriptive on the structure of care and funding, and to allow it to promote a portable assessment of need and financial support, with a continuing central role for local authorities in commissioning and funding social care services in their areas. It is clear that local authorities and the NHS must be partners in this, and that they must enable individuals to exercise greater control. The last thing we need is what the  Health Service Journal described last week as a takeover grab by the NHS for adult social care, or for primary care trusts to become responsible for all the commissioning activity and all the budgets.
	The Bill needs amendment and further consideration in this place. We will not divide the House on its principle, but it must be made flexible. That means it should be given time in Committee and on Report in this House not only to investigate what it actually means-the need for that is becoming more evident as we ask questions-but to amend it. The programme motion seems offensive in terms of parliamentary scrutiny. The Government seem to be making the assumption that, because the Prime Minister stood up at the Labour party conference and announced something, it should be passed through this House without scrutiny or question. The Prime Minister does not control the other place, but it is an abuse of this House for the Government to behave in that way.
	The Bill is required to be considered in Committee before its Report stage, and it needs to be reported to the House in the normal way, with an opportunity for further amendment and debate after adequate further reflection. So, although we shall not divide the House on the principle of the Bill, we shall divide on the programme motion later this evening.

Stephen Ladyman: I accept that it is objectively true that if we raised tax, we could afford it. My hon. Friend and I have had the debate many times before as to whether people would accept that level of tax increases, particularly if it were income tax or taxes on earnings. I personally do not believe that they would; I know that he is a strong advocate of the case that they would accept it if they knew that it was going clearly into social care-that is the difference of opinion we have. That is exactly why my preferred solution to the problem would be a hypothecated inheritance tax. I think that that would be far more acceptable to people at large than extra tax on earnings.
	That is a debate for another day. When the Minister winds up the debate, I want to hear how he sees this Bill fitting into the wider reform. If he cannot tell us today because he is not ready to produce the White Paper, he needs at least to give us the assurance that, when he does produce it, it will clearly say how the measures in the Bill are going to fit in.
	The hon. Member for South Cambridgeshire raised some points with which I had some sympathy. One is the exclusion from the Bill of personal care costs if people go into residential accommodation. If we are going to pay people's personal care costs if they have the most serious needs, I do not see why we would want to exclude meeting those costs in residential care. We should not go down the route of paying people's board and lodgings, as I believe that we all have a fundamental duty to contribute to our board and lodgings, irrespective of the level of our care needs, but we should eventually meet the element of residential care costs to do with personal care. I realise that that is excluded from the Bill, but when we produce the White Paper and move on to the next stage of reform, I encourage the Minister to indicate how that need is going to be met.
	Carers also need to be taken into consideration. As I said in an intervention, under the Community Care (Delayed Discharges Etc.) Act 2003, anyone making an assessment of someone's care needs also has to carry out a carer's assessment. It seems to me that if somebody is receiving personal care in their home and part of that care is coming from a voluntary carer, and if as part of the care plan that the Secretary of State talked about, the need for that carer to have some respite from time to time is identified, I would hope that we could include the cost of that respite within the ambit of the Bill.
	The issue of benefits is certainly going to be raised. I have spoken to the Minister and to the Secretary of State about my concerns. Frankly, I would deal with that by allowing people to continue to receive attendance allowance, and not reform it. I have previously described attendance allowance as the ultimate direct payment, since it is not means-tested and provides cash that can be spent however the person wants to meet their care needs, as long as they go over a particular care threshold. Because of that, it is very valuable. For people who have saved and have some income, as a result of which they are excluded from pension credit, it can be a godsend if a non-means-tested benefit is available to them.
	Having said that, I understand the Government's position that people cannot receive money twice, so if they are having all their care needs met, they cannot also expect to have attendance allowance on top of it. What we could do, of course, is continue to give people attendance allowance, but top it up to the level needed to meet their care assessments. In that way, we could maintain attendance allowance and meet the full cost of people's personal care, which is the aim of the Bill.

Stephen Ladyman: The hon. Lady is absolutely right. That is why I call attendance allowance the ultimate direct payment: it is cash to meet people's care needs however they want to meet them-and they could meet them through telecare; they could meet them through providing money for a carer; they could even use it to save up to provide respite care and pay it to a voluntary carer or a family member. As I say, it is theirs to do with as they like; for that reason, it is an incredibly powerful benefit.
	I take slight issue with how the hon. Member for South Cambridgeshire put it. If the Government chose to pass the value of the attendance allowance to the local council to meet someone's care needs, other legislation that we have at the moment means that someone can simply ask their local council to have their care needs met by a direct payment, rather than with direct care. In other words, they would get the cash back by another means if they wanted to go through that route. My argument is: why go through that route? Why not just leave the attendance allowance in place, with all its benefits, and top it up to the level of free personal care? I hope that the Government will ultimately come to that conclusion.
	In terms of how the money is to be provided to people to meet their care needs, I hope the norm will be that it should be provided in terms of a direct payment that they can spend how they want to meet their care needs the way that they want, which raises the question, of course, of how it will be assessed, whether it will be assessed by the normal processes councils go through at the moment when costing someone's care plan, or whether it will be some sort of flat-rate payment. Although a flat-rate payment might be simple, I would certainly not want to choose that particular route.
	The Government could have met their objectives in several ways, I guess. They could have had a much more complex Bill, which would clearly not have been passed before the general election, so it would not have given people in the most urgent categories of need the care that they need in the time scale that we are talking about. They could have done it as they have done by essentially putting the onus on local authorities to decide the care package. There was a third choice, which I do not know whether the Minister considered. That was to alter the criteria for NHS continuing care-bringing those criteria down to include the category of people with the most serious needs, so that the funds would effectively have come through the national health service.
	The Minister has chosen the route that he has chosen for good or ill, but I would like to suggest one way of achieving flexibility in the arrangements and perhaps even a better outcome for people. At the moment, local councils and local national health services can voluntarily choose to set up a care trust to manage the care of older people, in which case both parties put money together, which can be spent as the care trust decides. That gets over the problem that there are certain legal limitations on what the NHS can spend money on. Equally, there are certain legal limitations on what local councils can spend money on, but those limitations do not exist for a care trust. If everyone has put the money in together, it can be spent in the best way possible for the people concerned.
	At the moment, that is a voluntary arrangement for older people; it is not a voluntary arrangement for children, as we have reached a position where we insist on children's trusts being created to manage the funds from all the various agencies on behalf of children. I have never quite understood why we have not gone the next step and insisted on the creation of care trusts throughout England, which would also help to leverage in some extra money, I suspect, from the national health service, as well as from local government. It would give us considerable benefits in implementing this type of care plan.

Kelvin Hopkins: The hon. Gentleman has referred to significant developments over the past 12 or 13 years. Does he agree that the most significant of all was the report of the royal commission on long term care, which has been universally ignored?

Stephen Ladyman: I cannot stop myself from pointing out to the hon. Gentleman that Lord Lipsey was the member of the royal commission who wrote the dissenting report that the Government adopted, and that from the date it was produced until now the Liberal Democrats have been telling us that he did not know what he was talking about.

Stephen O'Brien: Does the hon. Gentleman agree that the economic modelling that lay behind the Green Paper might not have been made available in part because it had to be re-scrambled and meshed with the unbridgeable announcement made at the Labour party conference?

Norman Lamb: The hon. Gentleman is right in one sense, because he is advocating a comprehensive system that applies to everybody; when we start applying a process to one group of people, we create perverse effects and bureaucracy in determining whether somebody falls into or outside a category. He rightly identifies the need for a comprehensive solution.
	The hon. Member for South Thanet also accurately identified the risk of a disincentive for people to take out insurance. It is almost inevitable that insurance will be part of the overall solution that we seek to achieve-if we can build a consensus. The Bill inevitably amounts to a disincentive for people to take out insurance to protect against potential need. Who benefits from the measure? Remarkably, paragraph 5.21 of the impact assessment identifies the group that will benefit most as the "wealthiest older people". It is bizarre in the extreme and it is extraordinary that the Government have chosen a partial solution-rather than a comprehensive one-that, according to their own impact assessment, benefits most the wealthiest older people.
	There is also uncertainty about the cost and the number of people who will benefit. The impact assessment is riddled with uncertainty about the cost, and the Local Government Association has highlighted the point. First, the impact of take-up by people who are funding their own care is unknown; we do not know how many of the people who are currently funding their own care would come into the system. All we have is an estimate-that is all it can be. The Government say that they are confident that the figures are accurate, but they have no basis for that confidence. The impact of behaviour change with regard to residential care is unknown. The Conservative spokesman highlighted that the figures in the impact assessment are inconsistent with each other on that point. We do not know how many people will move from residential care to being cared for at home to take advantage of the offer of free care.
	The data on the number of those who are classified as "critical" and the relative distribution of their needs and disabilities are not collected centrally, so again we have no idea how many people we are talking about. We also do not know how many people are already receiving reablement. We do not know the proportion of those who after receiving reablement would not require care. Thus, the central assumption on cost and numbers in the impact assessment is uncertain. If the Government are wrong on their assessment of the total cost, what would be the consequences? We know from the consultation paper on the regulations that there is a fixed total sum available, so who would lose out if the figures were wrong? Will the criteria be tightened even more-beyond the calculation of "critical" need? Something has to give and the Government have not said what that would be.
	The LGA also raises serious concern about the potential for local government to fund its £250 million a year contribution. It is already making substantial efficiency savings, regardless of the £250 million that would be required. We know that over the past decade social care has been the poor relation of the health service in funding increases. At each spending round the health service receives a substantially greater real-terms increase than social care, and now the Government expect social care to come up with £250 million of efficiency savings to contribute to the cost of this measure. We have no way of knowing whether the system is capable of delivering that sort of sum. There is a real risk that it will amount to robbing Peter to pay Paul, taking care away from one vulnerable person to provide it to another whose financial resources may mean that they are actually better able to pay. The Secretary of State has today conceded that the total number of people who will benefit is 110,000-not the 400,000 that has been talked about. As the hon. Member for South Thanet said, the Bill benefits a very small subset of people.
	On specific issues relating to the Bill, I would be grateful if in winding up the Minister would deal with concerns that some groups have about the meaning of "critical". Will meeting just one of the critical areas, as defined, be enough to allow someone to qualify? What is the meaning of the "significant help" needed for the four daily activities? There is surely a need for greater clarity on that. Sense, the organisation representing deafblind people, refers to the fact that personal care, as defined in the Bill,
	"excludes the type of communicator guide support which is so vital to deafblind people."
	That group is one of the most at risk of having to go into residential care, but it is excluded from help-surely that cannot be justified.
	Where do we go from here? There are serious concerns about the perverse impact that this unsatisfactory measure could have. The most pressing priority is to put in place a comprehensive, sustainable system-one that will last, as has been said-that will guarantee care for those who need it most, funded in a way that is fair and recognising the reality of the public finances. There is an urgent need to build consensus. Any Government coming to power next year, of whichever party or parties, have a massive challenge ahead of them in resolving this issue-such a resolution is overdue. Given the state of public finances, there is a real risk that this issue will be pushed, yet again, into the long grass. Surely we should all commit now to a process to secure a consensus. It is in the interests of any incoming Government that a process is already in place to achieve that. We should establish now-we should not wait until the next Parliament-a cross-party commission with a defined remit of achieving consensus in a tight time scale. Let us just imagine how the public would react if they saw the three main parties agreeing to come together to recognise that this challenge must be faced and must be met without further delay. That is necessary and it is of acute importance, so I urge all sides to agree to a process that secures that consensus on a sustainable system that will last into the future.

Laura Moffatt: It is a pleasure to follow the hon. Member for North Norfolk (Norman Lamb), who spoke of things being kicked into the long grass-I suspect that a fair bit of that is occurring on the Opposition Benches to say the least. It is disingenuous for the Opposition to say that they do not intend to vote against the Bill in principle and then to go about trying to take it apart piece by piece and rubbishing it before it can get a head start.
	I thoroughly support the Bill. Of course there are difficulties and issues to clear up, but at the heart of it we need to remember that it is desperately wanted and desperately needed by many people who live in fear of their future. This House has a responsibility to respond to those concerns, and not only to consider the measures carefully, but to ensure that they are put in place.
	I firmly believe that the Bill is an excellent stepping stone to the much greater piece of work that is going on. Frankly, I would have gone straight for the national care service and forgotten about the consultation. It feels like motherhood and apple pie to me-like the early days of the NHS-to go ahead and set something up in that spirit. We should be considering social care in the same terms as the NHS. Of course, many people in the Chamber have had the opportunity to spend a lot of time examining the Bill in detail-including how we came to the position that we are now in-but I firmly believe that we need to get back to the principle of worrying about those who, without question, will benefit from it.
	With those people in mind, I want to give a few reasons why we need to buckle down and get the Bill into place. It is not only desirable, but much needed. I was a member of the nursing profession for many years before I was elected to the House of Commons and was deeply aware of those people who, without support and help at home, found themselves in hospital or in social care. There is nothing worse for an acute nurse to know than that somebody for whom they are caring could, with proper support, have been kept at home and had the comfort of knowing that they would be looked after in their own home. For the people for whom this Bill will be most helpful-those with the dementia range of conditions-entering hospital for rehabilitative care is often incredibly damaging. It is confusing and upsetting, families become upset and it is often obvious at that point that it could have been avoided. For that reason alone, and for the many patients whose cases I have in my head who could have avoided admission, I support the Bill.
	I was very interested to hear the Opposition suggest that carers would step away from helping their relatives if such a Bill were passed. Frankly, I found that insulting to carers. Anybody who undertakes that work knows very well that they want to work in partnership with the care services. They want to have time to be on their own and to be able to share their experiences with friends and families, without the constant burden of caring for their loved one. This Bill will help many hundreds of people to live their lives as carers in much more certainty.

Laura Moffatt: Indeed. I thoroughly concur with those views. That would improve the quality of life not only of the person in receipt of care but of the carers.
	Many authorities are beginning this work already and that is why I do not have the depressed view that we cannot tackle the problem at this point. A year ago, the previous Secretary of State, my right hon. Friend the Member for Kingston upon Hull, West and Hessle (Alan Johnson), came to launch our well-being programme in Crawley. The local authority has come together with NHS West Sussex to provide excellent care at home-not only education on eating and smoking, but a full service that includes advice on preventing trips at home. I can imagine how much better it will be when we have a more comprehensive home care service for those people.
	This Bill is utterly doable. It is disingenuous to say, "We thoroughly agree with it, but we will now produce 101 reasons why we do not believe that we can move forward." Those who will benefit from the Bill will listen carefully to those words-I shall ensure that they hear them. I hope that with due consideration of the Bill, in a reasonable and timely way, which of course we can achieve with one clause, we will move forward and get it in place. We can then move on to a national care service, which will be welcomed wholeheartedly in this country.

John Hayes: If the Bill were an emergency measure-an emergency response to a problem-it would have happened sooner, after all the circumstances with which it deals are well established and well known. If, on the other hand, it was not an emergency measure, it should have been part of a bigger Bill, a greater plan, as was envisaged in what the Government said earlier this year, as highlighted by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) from the Front Bench and by others.
	So one is left in a quandary about what the Bill is for. There are those in the Chamber who would take a cynical view. I alluded earlier to that view, my hon. Friend was kind enough to say, with irony. Some would say that it was purely a political calculation, but I like to think better of the Government than that. I cannot believe that Government Members would behave in such a low and dishonourable way. It would be certainly hard to imagine them doing so.
	I want to spend some time considering the Bill on its merits, however slim they might be. My hon. Friend identified the o prevailing themes that should have underpinned the legislation. He spoke of quality. If we were to break that down further in respect of care, we would talk about where care was provided, by whom, at what point and in what form. One might have hoped for a little more clarity about any or all of those aspects of care in the opening speech from the Secretary of State, but it was short on such details, as is the very small Bill itself. We are not left in any greater certainty about what is to be provided, where, when or to whom; or at least not exactly to whom, for although the explanatory notes make an estimate of the number of people affected, as my hon. Friend highlighted, this calculation is imperfect.
	From even a preliminary glance at the Bill, it seems to me that it is likely to have two profound effects. One is a displacement effect on what is already being done, and the second is a catalyst effect on what might happen. Let us deal with them in turn. The displacement effect could have severe repercussions, certainly for local authorities, which are to provide much of the service on an unfunded basis. From where will they draw the money and what other services will suffer as a result of this displacement?

John Hayes: Indeed. That very good point was made not only by my hon. Friend, but also by the hon. Member for South Thanet (Dr. Ladyman), who speaks with some authority on these matters. The hon. Gentleman asked the Secretary of State about the relationship with carers and the effect of the Bill on carers. In doing so, he was echoing the sentiments so strongly expressed when the Bill that the present Bill amends was introduced in the House back in 2002.
	The then Secretary of State, the right hon. Member for Darlington (Mr. Milburn), made it clear that the purpose of that legislation was to marry care with health and to take into account all the elements that constitute quality care-not merely the information provided by health authorities to those responsible for care, but some calculation of the various individuals and agencies that collectively comprise quality care. I shall have more to say about the 2003 Act, which has been mentioned several times in the debate, and about how the Bill marries with that precedent.
	There is a legitimate difference between principle and purpose. That is not, as it might seem, axiomatic. The principle on which the Bill is founded-that of care in the home-is shared across the Chamber. The purpose of the Bill, however, is less clear. Its purpose in respect of delivering that principle is-I put it as kindly as I can-questionable, because although the Secretary of State claimed in its defence that it was paving legislation, when challenged repeatedly through interventions and by the Opposition Front Bench spokesmen, he conceded, quite generously and certainly openly, that further legislation would be required. Indeed, he spoke of "a major reform" being necessary, but he made no attempt to suggest that this Bill was that major reform; he said merely that it anticipated the major reform that was essential to satisfy the principle and to deliver the objective that all Members share.

John Hayes: If we were having that debate at the beginning of the life of a new Government, or at the end of the first term of a new Government, that might be a reasonable point. But, as the Government have been in power for a considerable time, it is odd that this Bill should emanate at this juncture. As I have said, I try not to be cynical about these things, but a more sceptical person than I might argue, "Better a Bill that works later than an imperfect Bill now." If the hon. Gentleman's scenario came to pass, it is not only likely that the best bits of this Bill would be included in that legislation, but that, more significantly, proper consultation with all the interest groups, local authorities and representative organisations of those most affected by the legislation could and would take place. That process would inform the Bill, which as a result would change and develop.
	I see the Minister of State, Department of Health, the hon. Member for Corby (Phil Hope) in his place and I know him well because I shadowed him in another life, as it were, so I cannot believe that he does not find persuasive the argument that we really need to think again about the Bill. We need to measure its likely effects in terms put by various third parties. I shall refer to them later, because thus far it has not received an uncritical reception from the groups that I just mentioned. We need either to flesh it out, as my hon. Friend the Member for Eddisbury (Mr. O'Brien) proposes, or to withdraw it and start again.
	I say to the hon. Member for South Thanet that the people most affected want a Bill that is best; a Bill that works for them; they certainly do not want a short-term measure that has to be either amended or replaced rapidly with something quite different.

John Hayes: The shadow Secretary of State said that the issue was not just funding or organisation, but quality. My hon. Friend's intervention leads me to conclude that the problem is not only about quality, but-to go further than the shadow Secretary of State-about organisation and funding, because some the Bill's effects may be perverse. We agree with its principle, but its too limited nature may of itself be detrimental to the principle that we share.
	Chesterton said:
	"To have a right to do a thing is not at all the same as to be right in doing it".
	The Government certainly have the right to introduce this legislation, but I am not sure that a politician of the distinguished status of the Minister of State, Department of Health, the hon. Member for Corby (Phil Hope) would want this Bill on his record when he could have a much better Bill if he did the thing properly.

John Hayes: Yes. As long ago as 2002, when the Community Care (Delayed Discharges etc.) Bill, which this Bill amends, was introduced, the then Secretary of State pointed out exactly that. In introducing the Bill, he said:
	"Ours is an ageing society. We should not fear but celebrate that. However, it poses formidable challenges for our key public services in providing better, faster care to higher standards"-[ Official Report, 28 November 2002; Vol. 395, c. 501.]
	based on the desire for older people to have independence, not dependence. That is the principle that I am describing as the one on which we all agree, supplemented by an absolute determination that such care should be of the highest quality and provided from the best sources-that we get the who, what, when and where questions right.
	To that end, I will focus briefly on the principle of care at home. In doing so, I want to draw attention to the time of year at which we debate these matters. As we approach Christmas, it is appropriate to remember Charles Dickens, is it not? Chesterton wrote that
	"in everybody there is a certain thing that loves babies, that fears death, that likes sunlight: that thing enjoys Dickens."
	It is that part of us that also loves home and cares about the most vulnerable. Dickens himself wrote:
	"Home is a name, a word, it is a strong one; stronger than magician ever spoke, or spirit ever answered to, in the strongest conjuration."
	For me, the concept of home is at the heart of civilised life. This is much more than speaking about housing. To talk of housing is one thing; to talk of home lifts us on to a different emotional plane. Home stands at the bright centre of our lives; home is where lives start and end. It is where we return to at the end of each day, and where we hope to return to at the end of all our days. It is right that people should be enabled to live in their homes for as long as they possibly can and that we should provide adequate support in order for them to do so. My hon. Friend the Member for South Cambridgeshire referred to quality in respect of care. For me, that is intrinsically linked to the security, certainty and familiarity associated with the home, all of which contribute to care in all kinds of ways that are supportive not only of a reasonable quality of life but a reasonably healthy life.
	Ministers might claim-as indeed they have, not entirely convincingly; in fact, I do not think that they themselves are entirely convinced-that the legislation before us attempts to enable people to return to home at the end of their days, or to stay at home. However, the Bill's purpose is both limited and contradictory. It contains just two clauses, and that paucity of content reveals its true purpose. It is not intended to address the substantial reasons why so many people are forced from their homes and into care, but simply to help one person to stay in one home. That person is the Prime Minister, and the home is 10 Downing street. I have to conclude, reluctant as I am to do so, that this is, in essence, a political Bill fired by partisan interest. I know it is hard to credit, but I think I have to say it. It is fired by partisan interest rather than by a genuine desire to introduce meaningful legislation.
	That is not to say that Ministers do not care about these matters-of course they do. Members of this House across the party divide care about these issues because they encounter them in their constituencies day by day. No political party has a monopoly on care or concern, or on decent people. However, it does Government no favours when they put that genuine concern to one side to pursue a narrowly political interest.

Phil Hope: I am hugely persuaded by the possibility that the Conservatives, of whom the hon. Gentleman is a very eloquent representative, will support a comprehensive Bill on a national care service in future, as he has just said that he would like to see a much bigger Bill. May I take it from his remarks that the Conservative party is pledged to support the creation of a national care service in future?

Stephen O'Brien: I am glad to find that my hon. Friend has been paying such close attention to areas outside his own brief that he has articulated party policy very adequately. He made a serious point, on which the Minister sought to challenge him, about the question of consensus. I think there is a mood in the House that we need to try to establish, where we can, a consensus on the way forward on an issue that we can all see is coming down the track not just for our political generation but for those who succeed us.
	Does my agree hon. Friend that it would be quite interesting to get any invitation from Ministers to join them in a round-table discussion that might identify areas of consensus, and that we would be happy to accept it? Given the Minister's challenge to him, would not a good start be for the Minister to accept that if the Government amended the Bill to include our home protection scheme, that would protect not only the people whom he seeks to protect-a small number, according to the hon. Member for South Thanet (Dr. Ladyman)-but those whom we seek to protect, who are fearful because they might have to sell their homes to pay for long-term residential care?

John Hayes: I listened closely to my hon. Friend the Member for South Cambridgeshire-I was having a cheese sandwich at the time, but I like to follow these things from near or far-and what he actually said was that an insurance model might well incentivise insurance companies to enable people to stay in their homes. That is far from the parody that the Minister paints. The insurance model that the Government identified as a possibility in the Green Paper could well be constructed to incentivise insurance companies to bring about exactly that outcome. I do not take such a limited view of the options the Government described in the Green Paper as the Minister has come to. He has done so rather hurriedly, given that it was published only recently.
	It is clear that the No. 1 priority identified in the Green Paper is that we need more joined-up working. That has been touched on by contributors on both sides of the Chamber. The Green Paper states:
	"We need services that will keep people independent and well for longer...through better joined-up working between health, housing and social care services and between social care and the disability benefits system."
	As you know, Mr. Deputy Speaker, I have a long-standing interest in disability issues, and I wonder about the proposal that disability benefits should be redirected to local authorities to provide care. I wonder whether we are thus caught on the horns of a dilemma, on one hand trying to provide more personalised care and on the other depersonalising the benefits system. Joined-up working necessitates proper discussion with local government and a proper assessment of how it will do the job that the Bill gives it.
	The Green Paper mentions services
	"fully joined up between the NHS and the new National Care Service."
	However, I have heard nothing this evening to reassure me about the information provided by the health service to care services, or about the role of third-party organisations such as Headway, which helps many brain-injured people and with which I have been involved for many years. It allows people with acquired brain injury, often suffering from serious disability, to stay in their own homes. They are frequently younger people, whom we should not exclude from our considerations tonight.

John Hayes: I notice that the Minister freely acknowledges that. It is important that the views of organisations such as Headway be taken into account. Mechanisms must be put in place to ensure that the support given to people in Headway houses, which provide support for carers as well as the young people affected, is properly accounted for in the Bill. I hope the Minister will say something about that area of policy.
	The Green Paper also states that the benefits of a joined-up service are that
	"people receive more appropriate care in the right setting, reducing costs, improving outcomes and ensuring that services work together to keep people healthy and active wherever possible."
	I am not convinced that the Bill will ensure any of that. Its single substantial change will be made out of context and out of place and is born of short-term, limited and arguably political ambitions. As the King's Fund has warned, the Bill makes the Green Paper's proposals "incoherent". Age Concern and Help the Aged have spoken of the need for
	"fundamental reform of the entire care system".
	I and the Opposition Front Benchers anticipated the need for such a root-and-branch reform as a result of the Green Paper and the discussions it provoked. The Learning Disability Coalition has argued that the Bill contains "perverse incentives" that will prevent people from taking advantage of the most appropriate care.
	Surely we need an holistic approach, as my hon. Friend the shadow Secretary of State said, with an emphasis on more preventive care to ensure that more people stay in their own homes. That means that we must be sceptical about any plans for cuts in disability living allowance and attendance allowance, or any redirection of allowances into the care system that takes place without proper discussion and consultation with representative organisations.
	I invite the Minister to answer one or two further questions. Will he clarify the marriage between the care budget and the various allowances that will feed the process financially? Will he say something about the estimates he has made of the displacement effect on local government? Will he draw a clearer picture of the effect on wider services that my hon. Friend the Member for Beckenham mentioned? My hon. Friend the Member for Eddisbury, the shadow Minister, in summing up, will add to and amplify those questions, and he will of course have cleverer ones of his own, but speaking with an appropriate degree of humility on a subject of which my only knowledge is derived from representing the interests of my most vulnerable constituents, I ask the Minister, at least as a starting point, to deal with those fairly fundamental doubts.
	T.S. Eliot wrote:
	"Home is where one starts from",
	and as I have said, it is also where we frequently return to for care and support. The objective of facilitating more personal care at home is one that will be widely shared across the House, but it requires far greater consideration, and more careful reflection and proper planning, than is suggested by the Bill. To work, the measure must work well, and to do that, it must be carefully conceived and properly considered. We owe those who will be most affected by the Bill nothing less than that.

Tobias Ellwood: The Minister says that he is writing copious notes. Well, it would be nice to get an indication, either now or in the winding-up speech, of whether this Government are open to amending the Bill to beef it up and make it something we can respect.
	We are debating the Bill on Second Reading, which happens to fall three months before a general election. It looks like there has been a dash for policy and a rush to put a tick in a box, so I have to ask the Secretary of State, in his absence, whether he was constantly last in the queue when the Prime Minister was doling out time for Bills to be debated in Parliament. How many Parliaments have we had to go through before finally reaching the Second Reading of such a Bill? We now seem to have a concession: a small Bill squeezed in just before we go to the polls. That is a shameful exercise, I am afraid, considering the deterioration of the service, which has been remarked upon across the Chamber-the fall in the coverage of care and the rising costs of it over the past decade.
	The timing of the Bill is certainly questionable. It is also questionable in relation to the Green Paper, because we are midway through a wider consultation on the aspects of social reform. My intervention-the first the Secretary of State took-was, why are we having this Bill now? He could not give me a clear answer; he could not acknowledge the fact that the Bill is part of an electoral cycle, rather than solid policy being put forward.
	Also, we have to ask ourselves, what is not in the Bill? It is thin on substance and there is little to disagree with, but there is little in the Bill in the first place. The costs of the Bill have not been outlined at all. Perhaps we will get more clarity in the winding-up speech. We have had the pre-Budget report, which included a black hole in the finances. We now have a Bill that includes a black hole in the finances. It is vague about how local authorities will foot the bill without having a knock-on impact on other services.
	It is worth reminding ourselves what personal care means. It is personal hygiene, such as bathing, continence management and assistance with eating; personal assistance, such as dressing and so forth; and simple treatment. It does not include nursing, which is not seen as part of personal care. Returning to that Labour royal commission on long-term care, which reported in 1999, it recommended that long-term care should be split into living costs, housing costs and personal care, and that personal care should be available after an assessment and paid out of general taxation. Most of the recommendations were accepted, but not that one on the aspect concerning personal care. The reason cited was that there were not enough resources.
	It is peculiar that we have just had a huge recession-the biggest since the second world war-and suddenly finances seem to have been made available.

Tobias Ellwood: The Secretary of State nods, but why is he just nodding with me, rather than that being written in the proposal before us?

Andrew Lansley: My hon. Friend will have noted, as I did when he was quoting the Green Paper, that it included remarks about recognising people's ability to pay. The proposal in the legislation before us is that those in the category of people with higher care needs should be given free personal care regardless of their ability to pay. The principles for the National Care Service that the Government set out in the Green Paper are therefore not the principles on which they propose to legislate.

Chloe Smith: I thank my hon. Friend for his contribution. I will come to what our local authority has had to say on this matter, as I have had conversations about it. He is right that the aspiration to end the postcode lottery may well be laudable, but the practicalities of getting it right are far harder.
	I will now deal briefly with costs and how the proposal might work, on the basis of the bare detail that we have been given so far. I cannot resist noting a comment made from the Government Front Bench earlier that the proposal will be subject to the "normal spending review process". It is a shame that the Secretary of State has disappeared again, as I wanted to put to him that it is a shame that we have had no comprehensive spending review to help us determine how it fits into the bigger picture, in terms not only of the health budget but of where our country is going.
	The Secretary of State has told us that the Bill will require a contribution of £420 million from his coffers and a further £250 million from those of local authorities. As has been suggested by my hon. Friend the Member for South-West Norfolk (Christopher Fraser), and also by my hon. Friend the Member for Beckenham (Mrs. Lait), the co-ordination that the policy demands from local authorities is one of the main problems that we face. Informal discussions in which I have engaged with Norfolk county council, the local authority that I share with my hon. Friend the Member for South-West Norfolk, suggest that the council could incur a cost of £5 million. Perhaps the Minister will confirm that that could add up to £250 million if spread over an appropriate number of authorities on an annual basis. It should be borne in mind that Norfolk has already had to squeeze £15 million of efficiency savings out of next year's budget.

Jeremy Wright: It is a pleasure to follow my hon. Friend the Member for Norwich, North (Chloe Smith), because I agreed with a great deal of what she said. May I apologise to you, Mr. Deputy Speaker, and to the House for missing part of this evening's debate? I was chairing a meeting of the all-party group on dementia. As the Secretary of State said, many people with dementia will be directly affected by what the Government propose.
	I wish to start my contribution, as many have done, by applauding the Government's intention-it is right that we should do so. There are few more important issues than social care and it is right to make a start on this, but we cannot accuse the Government, over most of their term of office, of legislating with breakneck speed on it. The Wanless report, which asked a number of important questions about social care, was followed a considerable number of years later by a Green Paper that asked all those questions again, and now we have before us a Bill that proposes to answer part of one of them.
	If the Bill is even to do that, it needs to deliver on its promises, and that is where I am in entire agreement with my hon. Friend the Member for Norwich, North and with others who have made this point. If the Bill is incapable of meeting the expectations that it has raised, not least by its title, it will be a cruel deception for those who are most reliant on social care and who will hope for most as a result of what the Government are proposing to do. That is why the uncertainty over the potential demand for free social care-the Government have not set out the terms of that in the Bill, but I hope that they will do so in the regulations that will follow it-is so important. This is about the unknown impacts on those currently funding social care themselves who may subsequently approach the state for free social care, of those who will not subsequently choose residential care as otherwise they might have done, and perhaps even of those in residential care who may choose to leave that care and return home to be cared for there-as we know, many prefer such an option.
	As my hon. Friend said, if we do not know what the demand will be, we do not know what the cost will be. We have heard that the estimate of the cost for the first year is £670 million, £250 million of which is expected to come from local government efficiency savings-one can only imagine the joy with which that news was greeted in town halls up and down the land. The remaining £420 million is expected to come from the Department of Health's research and development, marketing and consultancy budgets. I refuse to believe that the Government spend anything like £420 million on the Department of Health's marketing and consultancy budgets, so a substantial amount of the sum must be expected to come from the research and development budget. I hope that the Minister will be able to reassure me, and the House, that that will not affect the crucial work that goes on, not least in the field of dementia, where we already spend too little on research. If we do not spend a great deal more, it is very unlikely that we will find the cure that we hope for or, failing that, effective treatments, which will reduce the demand on our social care system in the first place.
	If there is a gap in funding-it is at the very least foreseeable that there might be, given the uncertainty, as we have heard, about the figures-who will pay for that gap? Will it be local or national Government? I rather agree with my hon. Friends who suspect that the answer is likely to be local government, once again. We must be sure, if that is the case, that it will be given adequate support to enable it to meet that burden.
	Let me say a word or two about the detail of the Bill. I agree with many who have spoken that reablement-although I am with my hon. Friend the Member for Beckenham (Mrs. Lait) on the elegance, or lack thereof, of that term-is a crucial point. It is vital that we get people back into being able to deal with their own daily lifestyle needs to the extent that we can and to the extent that they can. However, I am concerned about the practical implication of that. It seems to me to be inconceivable that in order to move to a process of helping someone with reablement, there should not first be some form of assessment to ensure that they will benefit from the process. That means that there will be one assessment to ensure that somebody is suitable for reablement, a process of reablement and then another assessment, assuming that that is appropriate, to decide whether they are entitled to free social care under the criteria.
	We all know that assessment takes a long time-we all deal with constituency cases weekly that involve long-running processes of assessment, assuming that there are enough people to carry out the assessments in the first place, as my hon. Friend said. We also have to assume that we are capable of withstanding the extra pressure on the system that will inevitably be caused by the extra demand for the extra social care provision. That will include many people who have substantial care needs, but not quite the critical care needs required for the free social care, who will ask and expect to be given a reassessment. A great deal more assessment will suddenly need to be done, and if that assessment and extra demand on the assessment system is going to cause further delay, that is a concern. There will be a big step between those who are assessed as having substantial care needs and those assessed as having critical care needs, in much the same way as we experience with NHS continuing health care.
	Let us be charitable, however, and assume that we can establish whom we will be paying under this scheme and how we will pay for it. We still have to answer the question of what we will be paying for. I do not want to revisit the debate that we had last week on attendance allowance and disability living allowance, but the freedom to spend the money that one receives in the way that one chooses was crucial to that debate and, I suggest, it is important in this one, too. The Minister will have seen, as I am sure many other hon. Members have, that Carers UK, in its response to the Bill, which I accept broadly welcomed it, also expressed concern about the situation of those families where family members are prepared to offer care in the home but would value assistance with other things such as gardening, shopping, transport and so on. We have to ask whether the provisions will enable such families sufficient flexibility to have what they need rather than what the Government wish to give them. We come back to the question of how committed the Government are to their personalisation agenda, to which I fully subscribe.
	There are broader issues, too, about what we pay for. The Minister has heard me talk before about what is commissioned. That point applies to residential care but, in this context, it applies particularly to domiciliary care. We must consider not only how we pay for this, but, alongside that, what we are paying for. We must ask ourselves whether commissioners are commissioning the right things and whether they should, as they do all too often now, be commissioning for blocks of time-such as commissioning 15 minutes for a particular task-or whether there is a better way of commissioning good quality care. We have to ask whether it is acceptable for a different agency care worker to arrive on someone's doorstep every day of the week, when the advantages of having someone they know and trust and for whom they can leave the door open while they take the dog for a walk are considerable.
	Those are substantial issues that are as fundamental as the question of who pays for the care that is delivered. That is why it is regrettable that we are dealing with these issues piecemeal and we do not have the opportunity to consider what is being provided on domiciliary care, as well as who should pay for it. This issue is, as others have said, too important to deal with in a piecemeal fashion. We should not have had to wait for 12 years, from when one Labour Prime Minister said in a conference speech that it was very important to deal with social care and that it would be a disgrace if we did not. Now, suddenly, because another Labour Prime Minister wanted an eye-catching initiative to fill a passage in a speech, we have to legislate in haste to make things happen.
	A potential problem with the Bill is the fact that it has a big title but not much content beneath it. Aside from raising hopes unduly, it would be tragic if we were to miss the opportunity to discuss more substantially, even at the end of this Parliament, the big issues surrounding social care. Another problem with the Bill is the fact that it does not answer with authority questions about whom exactly it would help, how it would help them and how much it would cost to do so. It does not even try to answer the bigger questions that are thrown up by the social care debate for us all to address. That is a shame, and we could and should do better.

Joan Humble: May I begin by apologising to you, Mr. Deputy Speaker, and to right hon. and hon. colleagues, for arriving so late for this important debate? I was in Blackpool with the Secretary of State for Transport, who was making a very important announcement in the town.  [ Interruption. ] I could digress into the electrification of the Blackpool to Preston line, but I shall not. That is a debate for another occasion, especially as I have so little time.
	It is interesting to follow so many Opposition Members, and I am heartened that there seems to be unanimity. I hope that that has been displayed in the essential focus on what the Government are attempting to do, which is to provide care at home, free of charge, to the people who are deemed to be in the most critical need and at most risk. I am surely not the only Member of Parliament who finds, when they speak to adults with disabilities and to elderly people who are in need of social care, that those people much prefer to be cared for in their homes. The more domiciliary care that we can offer to such people, therefore, the better. Lest anyone should misunderstand me, let me explain that I visit a lot residential care and nursing homes, many of which are of a high quality. Representing a seaside town, as I do, I know that many people retire to the seaside and that some prefer to go into residential care when they are very elderly. The majority of those whom I meet, however, would much rather be supported in their own homes. That is why the Bill is so important. I have not met one such person who has disputed what we are trying to do.
	Everybody that I have mentioned the Bill to fully welcomes it, so let us start from that premise and move on to the questions that we need to ask so that we can get things right. The hon. Member for Norwich, North (Chloe Smith) made that point. We need to get the issue right, and to do so we need clarity about the sorts of people to whom we are providing a service, how that service will be assessed and whether there is sufficient funding to pay for a quality service. I know that my hon. Friend the Minister cares passionately about social care, and he will also want to get things right and to ensure that those issues are addressed and explored in more detail as the Bill goes through the House.
	I, too, want to place the Bill in the context of the Green Paper-an exciting document that cannot be seen in isolation. I disagree with Opposition Members on this point. It is a mistake to look at what has happened in social care simply through White Papers, Green Papers and royal commissions, because an awful lot has been happening on the ground. There has been a transformation in the delivery of social care with the whole personalisation agenda, direct payments and individual budgets. Also, the way in which professional social workers assess the needs of their client groups has changed dramatically. I want to ask the Minister how all those positive moves in the personalisation agenda can be carried forward in the Bill.
	We need to look at the assessment and eligibility criteria. My hon. Friend the Minister is working closely with professional social workers and is doing all he can to raise their status. They need to know how they are to assess need under the Bill. Age Concern has produced a long list of questions, which I am sure he has seen, and he will know the sort of issues that are being raised.
	If a person previously received a personal budget, what would happen to that budget? How will the personalisation agenda affect them? Will they still have a say about the intensive care they are receiving that will no longer be charged? If they are in that critical category, will their informal carers-family members-be able to have a say? The role of informal carers is important and their voice must be heard, but separately from the individual who is being cared for. That individual must have an assessment of their needs and the informal carer too should have an assessment of their needs. To pick up on the point made by the hon. Member for Rugby and Kenilworth (Jeremy Wright), we can do both: we can have an intensive package of domiciliary care for the individual who needs it, while also looking at the needs of the carer. I know of excellent befriending schemes, such as care and repair schemes that offer the gardening help he talked about, or that allow respite care for informal carers.
	The Bill should not be considered in isolation, but as part of the package that is offered.

Stephen O'Brien: It is interesting to follow the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble), who is from Conservative-controlled Lancashire.
	As the former Prime Minister, John Major, might have said, this is not an insignificant day. It was another former Prime Minister, Tony Blair, who promised at the 1997 Labour party conference that no one should have to sell their home to fund their long-term care. Twelve years on we are debating the first bit of relevant legislation. There were three Labour Back-Bench speeches, none from the Liberal Democrats, and no fewer than six from Conservative Back Benchers. If ever there was a true benchmark of care, that is it.
	One question that Ministers must ponder is how they could do more through the Bill.  Which? called it "a missed opportunity". The House will recall that the policy behind the Bill was announced by the Prime Minister in his speech to his so-called comrades at the Labour party conference. Cleared just 20 minutes before the Prime Minister's announcement, there was no hint of the policy in any of the preceding debate. It undermines the Green Paper process, and the speed of its gestation puts the policy on infirm evidential ground. Take, for example, the use of a blog as an authoritative source in paragraph 5.27 of the regulatory impact assessment:
	"see http://healthcare-legislation.blogspot.com/2009/11/does-acturarial-value-trump-medical-loss.html".
	That must be a first.
	Lord Lipsey, who sits on the Labour Benches in the other place, branded the Bill a "gimmick" and said that
	"it is a bad policy but also a very bad way to do policy just to find a nice highlight for your Labour Party conference speech."
	If Ministers can churn out that policy in a couple of days and try to rush it through Parliament with only a single day in Committee of the whole House-patently a ruse to bypass questioning and to bang it through for, as some say, electoral purposes; surely not-and if they can expedite the Bill, could they not also, given that the Green Paper consultation has concluded, support legislation to address some or all of the other parts of the social care waterfront? As my hon. Friend the Member for Bournemouth, East (Mr. Ellwood) asked in a trenchant speech, "Is that it?"
	One way that the Government could show their earnest in their call for a consensus is by agreeing to amend the Bill to bring into effect our home protection scheme, a policy that deals with another part of the social care agenda, for which the costs can be much more catastrophic to individuals than even those for the critical level of domiciliary care. We never claimed that our scheme would solve all the issues, but it is an essential part of such a solution.
	The House must remember that the Bill deals only with those with critical needs. Those whose needs are substantial, moderate or low are ignored. It addresses only those who stay at home. Those who opt for, or have to go into, residential care are left out. In the Green Paper, the Government said that in 2012 there would be 6 million people with care needs. The policy that we are debating claims to help just 270,000, and even that figure has been called into question. It represents less than 5 per cent. of the total. The point was highlighted against his own Government by the hon. Member for South Thanet (Dr. Ladyman), who said that the Bill covered only a small part of care need, not the total architecture. It is our hope that the Government will expand the Bill's horizon and ambition.
	The Government must do more to assure us that the Bill will not fall foul of the Human Rights Act. It has one of the longest depositions to the human rights committee that I have ever seen. The Government must work hard to suggest that it is not unfair to give people a differing amount of state support, depending on where they live. Many organisations, such as the Learning Disability Coalition, have expressed concern at the perverse incentive that the Bill could provide for people, who would be better in residential care, to stay in domiciliary care against all personalisation principles-the very issue about which the hon. Member for Blackpool, North and Fleetwood expressed concern.
	According to the impact assessment, the purpose of the Bill is
	"Funding care to those in need at the time of their need"-
	close to what the Prime Minister said at his conference, and uniquely for a policy of this Government, seeking to provide peace of mind to everybody. However, the Government changed the purpose for the European convention on human rights sign-off to
	"enabling, supporting and encouraging more people to avoid or delay entering residential accommodation".
	The former and, some might say, real purpose of the Bill might well fall foul of the courts, so we need to ensure that the Bill does not proceed through the House on a flawed basis. That is just one more reason for more time in Committee than the proposed day on the Floor of the House.
	In the course of a comprehensive, tour de force of a speech by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), who opened for the Opposition, the concern was also raised that the legislation incentivises care homes to re-brand as extra care. The hon. Member for South Thanet picked up that point, too, although in an otherwise very fair-minded speech, he did not seem to grasp the argument that the Opposition have cogently made. Given how the Bill might operate, there is no indication that a care home will have to do anything more than bill its residents separately for accommodation on the one hand and care on the other to qualify, under the terms of the Bill, as an establishment that does not provide accommodation together with care. That could bring the whole 500,000-person strong, £1.2 billion cost of residential care within the ambit of the scheme.
	There are questions about reablement, a word that my hon. Friend the Member for Beckenham (Mrs. Lait) found difficult to deal with. Let us call it occupational therapy, if she prefers. Will it be available to those with palliative care needs who can live for many years? Why have the Government assumed that one quarter of people will not be processed-a worrying enough word in itself-each year? Will the Bill's stipulation that reablement must come before free care create a perverse incentive to councils to delay reablement work? That is another key area, and it clearly needs deep Committee scrutiny if we are to get to the bottom of it.
	There is little joy for carers in the Bill, as the assessments will not be carer-blind. The Government have put ever-increasing pressure on carers, and the Bill is likely to exacerbate that. My hon. Friend the Member for Braintree (Mr. Newmark) echoed that concern in his interventions on value and, even, non-financial value-something about which the Secretary of State was concerned when he was a Minister.
	The Secretary of State has also spread confusion about the NHS "taking over" social care. Despite the pre-briefing, nothing new was announced, but now councils think that they are about to be shot of the problem. Furthermore, the narrow focus on care rather than support might mean that people who could stay in their homes will be driven into residential care. That is the very mischief that the Minister of State, Department of Health, the hon. Member for Corby (Phil Hope) persistently, wrongly and, I am sure, without any party political slant at all seeks to portray as the problem, as he perceives it, with our very well-received home protection scheme. Scope says:
	"By overlooking the needs of deafblind people to communication support, the government is in effect excluding a group of people who are most at risk of having to enter residential accommodation."
	Another area with which the Government are, frankly, playing fast and loose is the finances of the scheme, a point clearly and compassionately made by my hon. Friend the Member for Beckenham on behalf of her constituents. They include my elderly parents-in-law, who are in receipt of the very good services in Bromley and, let it be said, vitally, the attendance allowance that helps them to stay in their own home-with all the benefits that that brings.
	The impact assessment provides costing only for two and a quarter years. I have never read an impact assessment that has not costed a policy for at least 10 years. The period of two and a quarter years brings us to a certain magical part of the calendar and is clearly another part of the impact assessment's panic drafting. The Government's own Green Paper looked to 2050, and, in this vital area, that is the span that we all know we must consider.
	The impact assessment confesses that there is "inherent uncertainty" in estimating the costs. I asked the Government, through parliamentary questions, to extrapolate the amount, even using contemporary assumptions, but they repeatedly refused. Doing it myself, therefore, I found that the policy will cost at least £1.2 billion a year by 2030. If their assumptions are wrong by just 1 per cent., and that is almost guaranteed with this Government, that will add about £40 million to a £650 million cost in the first year.
	The Local Government Association is particularly concerned that the Government have "underestimated". If the Government are serious about this policy being part of the reform of the system, they must bring forward the proper costings, as my hon. Friend the Member for South Holland and The Deepings (Mr. Hayes) said in a wide-ranging, exemplary and significant contribution that had his constituents' interests at heart throughout.
	During the general debate on health and social care reform on 29 October, in response to some pressure from Members on the Government Benches, the Secretary of State ruled out funding from general taxation because it would not
	"be fair across the generations to ask the working-age population to pay for the costs of care"
	and
	"it would not be honest or straightforward to give the impression that we can fully fund a care system entirely from general taxation."-[ Official Report, 29 October 2009; Vol. 498, c. 479-481.]
	Those reasons were also cited in the Green Paper. He therefore needs to explain why it is "honest" or "fair" to do that through this policy but not the whole reform, and how a policy clearly at odds with the principle of the Green Paper can be said to be in its direction of travel-a point ably highlighted in a comprehensive speech by my hon. Friend the Member for Norwich, North (Chloe Smith). It was precisely this tension that led my hon. Friend the Member for Poole (Mr. Syms), in a clear and caring speech that focused on his constituents' needs, to argue so powerfully for the detailed and adequate scrutiny of the Bill-that is, in a proper Committee stage instead of one day on the Floor of the House.
	Furthermore, Ministers have not yet come clean on exactly which budgets they are slashing to pay for this measure. Some £250 million, which was spun as a real-terms cut in the pre-Budget report, is set to come from as yet unrealised local government "efficiency savings"; in other words, they are going to spend it on this instead. Many organisations, including the Learning Disability Coalition, Age UK and Sue Ryder Care, have pointed out that this
	"could mean cuts for other people with care needs".
	The LGA has said:
	"It is difficult to see how local government could meet the cost of this proposal from current plans for efficiency savings, without the lifting of other burdens."
	When pressed through parliamentary questions, Ministers have given the reply, devoid of hope for these organisations, that setting charges for social care is a matter for local authorities. We know that the Government are also taking it out of research budgets but have not yet identified which ones, generating great concern particularly among cancer charities and-as highlighted by my hon. Friend the Member for Rugby and Kenilworth (Jeremy Wright), whose speech was, as always so focused given the information and expertise that he has in chairing the all-party group on dementia-among dementia charities, to whom the Minister of State only recently pledged more funding. The Government are also taking it out of the NHS IT budget, which funds a programme that, according to Ministers, was all about patient safety, patient care and a more efficient use of public money-until last weekend, when it became, to quote the Chancellor,
	"frankly...not essential for the front line".
	It is important that Ministers clarify exactly where the money is coming from. The House will see that this scrabbling together of money from different pots shows that the Government seem to have no idea of how to fund this measure in the long term.
	On the positive side, one of the exciting additions to the Bill could be legislation to underpin our home protection scheme. This would enable every 65-year-old to buy into a risk pool at the cost of £8,000 or so, insuring them against the catastrophic costs of admission to residential care. It delivers on Tony Blair's promise in 1997 to stop people having to sell their homes to pay for their long-term care; last year, 45,000 people had to do just that. These people probably did not grow up with parents who owned property but have been enabled to get on to the property ladder, many in the 1980s, and who could have given their children and grandchildren a start in life that they themselves could never have dreamed of. Instead, once again, the Government have got rid of a driver of social mobility. Of course, the policy will be attractive only to those who would otherwise fail the means test; it is right that those with assets under £23,000 should continue to be supported by the taxpayer.
	This is not the time for a litany of failure on social care-the point is made by the gap between Tony Blair's 1997 pledge and this Bill, which shows only the first glimmer of full-scale reform. So much for the demand made, not least by Conservative Members, that truth be given to the aspiration allegedly contained in the Green Paper. In the last general debate, the Secretary of State spoke of his desire to create "unstoppable momentum" for reform. It is a somewhat plaintive cry as he positions himself, I would argue, for the future and his campaign for the Labour leadership. We wish him well; he would be a great asset to us. If he truly wants to create that momentum, he will work with us, not against us. Despite his confession to me, some months ago, that he is tribal at heart, I hope that he can none the less see a way to working with us. A beginning would be to give the Bill due time in Committee, not just a day on the Floor of the House. Of course we must and will divide the House to oppose the programme motion, while not opposing Second Reading. As I have said and as my hon. Friend the Member for South Cambridgeshire said in his opening speech, the Bill contains some worthwhile provisions but should be set in an overall architecture, rather than the Government taking this spatchcock approach to legislation.
	My favourite part of the regulatory impact assessment is paragraph 5.29, which notes the risk that
	"current research and evidence available does not accurately estimate the true numbers who may come forth to seek assessment and services."
	The archaism "come forth" suggests a draftsman who sees the policy for what it is, but it also gives us some ground for optimism-those are, after all, the words that brought Lazarus from the grave. I hope that if Ministers are willing, we can resurrect social care reform across the whole spectrum of care in this Parliament rather than be forced to wait for the next, when the House can be assured that if given the chance, we will act.

Phil Hope: The question of how we create a fairer, more affordable system of care and support is one of the defining issues of our day. From my visits to people being looked after in their own homes and my meetings with carers, I know how much it matters to individuals, families and communities. It is a subject that deserves serious, non-partisan discussion in the House. We have had many contributions worthy of it, and I welcome the forewarning that the hon. Member for South Cambridgeshire (Mr. Lansley) gave me before the Committee stage in the new year, with his detailed questions about the impact assessment. I look forward to debating them further in due course.
	Apart from the final contribution by the hon. Member for Eddisbury (Mr. O'Brien), we have had a welcome absence of scaremongering or political point scoring. At the start of the debate, my right hon. Friend the Secretary of State laid out the challenge ahead and explained how the changes to our society in demography, life expectancy and better medical treatment spell out the need for decisive action on social care.
	We know the salient facts. This is a country with more pensioners than people under the age of 16. The Office for National Statistics suggests that by 2033 the number of people aged over 85 will rise from 1.3 million to 3.3 million and the ratio of working-age adults to pensioners-the so-called dependency ratio-will drop below three. By 2050, it will fall to the point at which there will be only two working adults for every pensioner. The facts speak volumes about the need for bold and far-reaching reform. The message is stark: without radical action, our ability to meet the needs of our ageing population will decrease, and the unfairness that we already see across the care system will mount year on year.
	I thank my hon. Friend the Member for Blackpool, North and Fleetwood (Mrs. Humble), who said that there had been a transformation in social care over the past few years. That was in stark contrast to the views of the hon. Member for South Cambridgeshire, who opened his remarks by criticising the lack of action. He neglected to tell the House about the 50 per cent. real-terms spending increase on adult social services since 1997, or the £500 million grant given to councils in the past three years to help personalise social care services and pursue the personalisation agenda that many Opposition Members reminded us about. He neglected to mention our efforts through the national dementia strategy, which I had the privilege of launching earlier this year, or the ministerial research group that I launched following the national summit to ensure that more resources go into researching the causes of and cures for dementia and the care of people with it.
	The hon. Gentleman did not mention the work under way through the carers strategy to support the friends and families who make such an important contribution to our society, the existence of 11,000 dignity champions throughout our health and social care system, or the fact that the Care Quality Commission report on care and council performance published earlier this month showed that 80 per cent. of homes and agencies and 95 per cent. of councils were rated as "good" or "excellent". Opposition Front Benchers completely ignored and overlooked all that progress.
	Despite the progress, we know that the structural changes in our society call for wholesale reform of our care system. That is why our proposal to create a national care service, which many Opposition Members have lauded and applauded so much this evening, is so important. I am delighted that so many hon. Members have now seen the light and are following Labour's lead in forming a national care service for the future, which will be fairer, simpler and more affordable, underpinned by national rights and clear entitlements, driven by quality and built around the individual's needs.
	Many hon. Members discussed the importance of improving quality. Let me remind the House of what we are doing on raising skills in the work force-another issue that has been debated this evening. For example, we have created a National Skills Academy for Social Care, driving forward training, development and career progression for the adult social care work force. Our social work taskforce sets out how we further support the social work profession. We are doing more to attract young people into the care work force, not least under our "Care First" career scheme, which was launched earlier this year, and by creating an extra 1,000 apprenticeships opportunities.
	We are also ensuring that a clear and wide range of interventions are available. The hon. Member for South Cambridgeshire was highly critical, but he forgot about "Putting People First" and the £60 million we made available to local authorities to encourage investment in telecare and supportive mechanisms to help people in their own homes. Our recent publication on the use of resources further promotes the use of such early interventions and preventive responses. Therefore, to suggest that there has not been a period of investment, reform and change over the past 10 years is to deny and ignore completely what has happened; and frankly, it will leave those who have done so much work on the ground feeling that the Conservatives do not know or care about their work.
	The Bill is part of that journey and an important bridge to a national care service. Let me set out clearly what it stands for. First and foremost, it represents action now for 280,000 people with the highest level of need-those with advance dementia and Parkinson's disease. It will remove the unfair burden of cost on those people and their families. My hon. Friend the Member for Crawley (Laura Moffatt) made a heartfelt plea, based not least on her experience of working with people with dementia, for more help now to prevent the unnecessary admission of people with advanced dementia to hospital.  [ Interruption. ] I share her concern about that, yet for five hours, Tory Members have found reason after reason for not going ahead with the Bill. We have heard them say, "It's only a part of the jigsaw, so do nothing"- [ Interruption. ]

Phil Hope: I am not going to give way, because I want to address the point made by the hon. Member for South Cambridgeshire and answer some of the other points that he and his hon. Friends made in saying that under the Bill, such care would be free.
	I regret that the hon. Member for Beckenham (Mrs. Lait) does not share our concern about families who have had to run down their savings and now face high costs because of high needs. The people who will benefit from this Bill mostly do not have high incomes relative to the population as a whole. It is the cost of care for those people that would be met, and it would be driven through personal budgets-a key issue that many hon. Members raised-so that they get real choice and real control over the kind of services they need to live their lives as they want to.
	Many hon. Members also supported the principle of reablement support to help lift another 130,000 people at a low point in their lives, perhaps after a bereavement, a fall or a period in hospital. Reablement will help people to regain or retain their independence. The Bill will help us to drive forward a process to provide reablement care not just in a few councils but in every council, so that people will get the physiotherapy and personal support to learn how to perform daily tasks after an illness or injury. They will also get the adaptations to their home to make it wheelchair friendly. We will use new technology and telecare such as alarms and electronic pill dispensers to improve safety. By extending that support to those with lower level needs, we can help to reduce the isolation that can occur and keep these people active. We can prevent people from slipping to the point where more intensive care and support is required.
	My hon. Friend the Member for South Thanet (Dr. Ladyman) raised the question of carers' support needs being met. As part of the user's assessment, there will be an opportunity to consider the carer's needs in designing the care and support package. The carer will also be entitled to ask for a specific care assessment to ensure that their needs are identified. I regret the hon. Member for Eddisbury's claim that this Bill will create more of a burden on carers. It will help to free up financial resources, which can then be spent to alleviate the caring burden.
	Questions were raised about discrimination between those in residential care and those being cared for at home. I draw hon. Members' attention to the explanatory notes that accompany the Bill and spell out clearly why the different treatment of people living at home is not discriminatory. In the time I have, I cannot spell out the details, but hon. Members can read the notes.
	Caring for the most vulnerable in our society is now quite rightly taking centre stage in our politics. It is an issue that arouses strong feeling, and a challenge that this Government are determined to tackle in the fairest possible way. We have a long way to go to create a national care service and to do for social care what the NHS has done for health care-to eradicate the fear and uncertainty that surrounds people with care needs.
	We said when we launched the Green Paper that we wanted to build an unstoppable momentum on this issue. Failure to take forward radical reform would compound the unfairness, would mean an inadequate care budget being stretched to breaking point, and would mean more and more people being denied the help they need. I do not want to live in that sort of society-in a dog-eat-dog world where people have to fight tooth and nail to get the care they need. Today's Bill is about turning our backs on that depressing vision and embracing a future in which care is provided on the basis of need, not wealth. Unquestionably, there will be challenges ahead to improve quality, provide guarantees of services and standards and end the lottery in social care. However, today we take a decisive and necessary step forward, and I commend this Bill to the House.
	 Question put and agreed to.
	 Bill accordingly read a Second time.

Motion made, and Question put forthwith, (Standing Order No. 8 3 A),
	1. That the following provisions shall apply to the Personal Care at Home Bill:
	 Committal
	The Bill shall be committed to a Committee of the whole House.
	 Proceedings in Committee, on consideration and Third Reading
	2. Proceedings in Committee, any proceedings on consideration and proceedings on Third Reading shall be completed at one day's sitting.
	3. Proceedings in Committee and any proceedings on consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced.
	4. Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.
	5. Standing Order No. 83B (Programming committees) shall not apply to proceedings in Committee and on consideration and Third Reading.
	 Other proceedings
	6. Any other proceedings on the Bill (including any proceedings on consideration of Lords Amendments or on any further messages from the Lords) may be programmed.- (Mr. Blizzard.)
	 The House proceeded to a Division.

Stephen Hammond: Is not the nub of the issue what my hon. Friend the Member for Upminster (Angela Watkinson) said, which is simply that, regardless of whom we put on to the Committee, its purpose is to scrutinise regional bodies, but a lot of London's regional bodies report to the Mayor and there is already scrutiny of the Mayor, so this is complete duplication?

Tom Levitt: On a point of order, Mr. Speaker. Further to your answer to the recent point of order, I note that the hon. Lady has still not got around to talking about the people named in the Order Paper. Surely she should do so straight away?

Justine Greening: My hon. Friend raises an interesting point. I think that most people would be concerned if the hon. Member for Hendon were on a Select Committee, because his questions might be longer than the actual evidence given to it.
	I was looking through the résumés of some of those proposed. I do not know whether the hon. Member for Islington, North (Jeremy Corbyn) is in the Chamber tonight. It may be that he is, once again, attending the Pugwash conference-he went to the one in Canada last year. We have some concerns and we are not convinced that this is the right way in which to go.

Mr. Speaker: Order. I know that the hon. Member for Uxbridge (Mr. Randall) will understand when I say that we do not want a dewy-eyed, romantic debate about- [ Interruption. ] Order. The House does not want a dewy-eyed, romantic debate about geography. We are focusing, and I know that he will now focus his remarks, not on geographical areas, but upon the particular qualities of the Members proposed for the Committee.